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Short-term and long-term disability income benefits

Are you a plan administrator?

Use these forms to support a plan member's claim for short-term or long-term disability income benefits. You'll find instructions on how to return the completed form on the form itself, or you can submit your form onlineOpens a new website in a new window - Opens in a new window

Download a form

Download the form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new window - Opens in a new window (not your browser) and save.

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I'm a plan administrator

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