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Disability Benefit Application Forms

We encourage you to contact TRA to request a disability benefit estimate and additional details about applying for permanent and total disability benefits.

Contact TRA at 651-296-2409 or 800-657-3669.

View our Disability Coverage booklet.

Forms are provided in PDF format. Open and print these forms using Adobe® Acrobat® Reader.

ALL forms must be completed and returned to:

Teachers Retirement Association
60 Empire Drive, Suite 400
St. Paul, MN 55103-4000

Disability Benefit Application
Physician Report (medical examination reports (print two copies)*
Medical Release of Information
Employer Certification of Service Separation
Federal and State Withholding Certificate
Direct Deposit Agreement TRA-4400

*One Medical Examination Report may be completed by a licensed physician, chiropractor or psychologist, while the second report must be completed by a licensed physician.

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