U.S. flag

An official website of the United States government, Department of Justice.

Public Safety Officers' Benefits Disability Benefits Program: Required Documents - Filing a PSOB Disability Claim

NCJ Number
Date Published
2 pages
This fact sheet explains the documents required in submitting an application for disability benefits regarding a law enforcement officer's and other designated public safety personnel's line-of-duty injury under the federal Public Safety Officers' Benefits (PSOB) Program.
Part A of the application must be completed and electronically signed by the disabled officer or authorized representative. Part B of the application must be completed and electronically signed by the head of the former employing agency or designee. The Agency Accident or Incident Report contains information relevant to each incident and injury that contributed to the officer's disability. A statement signed by the disabled officer or authorized representative includes the following information: 1) the highest educational level achieved by the disabled officer; 2) any special training or courses completed by the officer, including military training; and 3) whether the disabled officer has worked at any job following his/her line-of-duty injuries, and if so, where. The application for disability benefits must also contain IRS "Wage and Income Transcripts" for the past 3 years. Medical documentation is required as well, including admission and discharge summaries from medical facilities and a final medical diagnosis for each injury. Distinctive requirements for disabled employees of Volunteer Fire Departments, Rescue Squads, or Ambulance Crews are outlined. Because each PSOB case is unique, additional information may be requested to clarify or establish the eligibility of claims and beneficiaries according to the PSOB Act and its regulations. Applications are to be filed online at www.psob.gov.

Date Published: January 1, 2018