DP Fire Pension Board Rules (Updated 12/2019)

Freedom of Information Act (FOIA) Disclosures

Application for Membership

Background Information Form

Physician's Certification Regarding Entry Level Physical Condition

Affidavit of Continued Eligibility

Affidavid of Eligibility Disability Pension Annual Examination

Authorization to Disclose Protected Health Information

Physician's Certification of Disability

Physician's Recertification of Disability

Change of Data/Records

Maintenance of Pension After Separation of Service

Application for Retirement Pension Benefits

Estimate for Retirement Pension Benefit

Application for Disability Benefits

Application for Widow/Widower and/or Dependent Benefits

Initial Request/Inquiry as to Reciprocity (Combine Article 4 Service),

Military Service Purchases, Article 4 Service Transwers,

and/or Retirement Pension Benefit Estimates

Election to Purchase Military Service Served Prior to Employment

Initial Inquiry for Costs to Combine Creditable Service

Request for Conversion Calculation

Application for Conversation of Disability Pension to Retirement Pension

Qualified Illinois Domestic Relations Order (QILDRO)

QILDRO Calculation Order

Consent to Issuance of QILDRO

Request for Certified Statement of Accumulated Contributions, Accrued Benefits and Other Interests

Statement of Financial Interest in Response to QLIDRO for Payment of a Percentage of a Retirement Benefit (Before)

Statement of Financial Interest in Response to QILDRO for Payment of a Percentage of a Retirement Benefit (After)

Consent of Alternative Payee to Retirement Benefit Election that Diminishes Payment to Alternate Payee

Application for Termination of Disability Benefits

Application for Refund of Contributions

Creditable Service Claim Form and Affidavit

Request for Calculation for Potential Transfer of Creditable Service Per

P.A.100-0544 (HB0688) From Article 4 to Article 6 (Chicago)