Have you become disabled?
Fill out the forms
To receive Disability Benefits, fill out the application below and either print and mail it back, or upload the forms and all related documents using our secure Document Upload Center.
Everything you need to get started is included in the application, and you must fully complete each section to avoid a delay. It is very important that you provide us with timely notice of your disability, complete the entire benefit application, and send us all appropriate documents such as proof of age, marriage certificate, Social Insurance Award, etc.).
Please note (Section 4.13 of the Pension Plan) that Disability Benefits will be suspended during Reemployment.
Download Application
1 Disability Benefits Application
Start by filling out your background information and employment history. Be sure to list all employment, regardless of whether you were covered by the Fund's pension plan. Start with your present or most recent employer. Please add additional pages for employment history if needed.
You must attach/include copies (not originals) of all appropriate documents including:
- Copy of your birth certificate (or other proof of age)
- Copy of your spouse's birth certificate (or other proof of age)
- Copy of your marriage certificate
- Copy of your divorce decree
- Copy of your complete Social Insurance award
- Copy of your military discharge papers (DD214)
Be sure to sign and date the application to avoid any delay with your benefit.
2 Tax Withholding Form - IRS Form W-4P
You are responsible for paying all applicable federal tax on your pension benefit. You have the option to have federal income taxes withheld from your pension benefits. If you have too little tax withheld, you may owe tax when you file your tax return and may also owe a penalty unless you make timely payments of estimated tax. If you have any questions regarding your tax withholding, please consult your tax professional. Unless you are otherwise contacted, if you do NOT file a federal income tax election with us, the Tax Equity and Fiscal Responsibility Act requires us to withhold income tax as if you are single.
Please note that the IRS does not allow for a specific or flat amount to be withheld.
To elect to have federal taxes withheld from your pension benefit based on IRS tax tables:
- Print your name, address, and social security number in the space provided.
- Check your anticipated filing status in Step 1(c).
- Complete steps 2 - 4 only if they apply to you.
- Pay close attention to the instructions on the form and when instructed to add multiple figures.
To elect not to have any federal tax withheld:
- Print your name, address, and social security number in the space provided.
- Write ‘No Withholding’ in the space below Step 4(c).
3 Benefit Payment Method Form
This form is required to initiate Disability Benefit payments – no other form will be accepted. You must keep the Fund informed of any change in your address, regardless of which payment method you chose.
Direct deposit:
Directly depositing your monthly pension check into your bank account is the fastest and most convenient way to receive your pension. Avoid the trip to the bank and sign up today.
Payment is deposited electronically into your checking or savings account on the first day of each month (unless the first day of the month falls on a weekend or a bank holiday). Because of processing time, your first and/or second payment may be sent by mail.
If you change banks in the future, you will need a new form.
Send me my check by mail:
Every effort is made to ensure your check is received on the first day of each month. Because of circumstances beyond our control, there is no guaranteed delivery date. In the event a replacement check is necessary, one might not be issued until the 10th day of the month.
Sign and date the form when finished.
4 Send Us the Form
Be sure to return the entire completed application.
Document Upload Center:
Mail:
Central States, Southeast and Southwest Areas Pension Fund
P.O. Box 5109
Des Plaines, IL 60017-5109
Fax:
Still need help?
Contact one of our Benefits Specialists for more information on Disability Benefits.
