March 15, 2023
Circular Letter: 200-014-23
Topic: Retirement Benefits

To: All Contracting Agencies With Local Safety Members


The purpose of this Circular Letter is to inform you of the forms and information that the California Public Employees’ Retirement System (CalPERS) requires to support any determination findings for members with substantial incapacity.

This applies to all applications for disability retirement (DR) or industrial disability retirement (IDR) and reevaluation for continuous eligibility for such retirement.

Required Forms and Information

CalPERS must receive the following documents to process agency determinations. Incomplete or insufficient information will delay processing of the member’s application.

CalPERS requests this information for the following reasons:

All information required is necessary to ensure that DR/IDR benefits are provided only to eligible and qualified members.

Instructions for Completing the Forms

The following forms are available online under Disability Retirement Resources for Local Safety Agencies. It is your responsibility to ensure forms are completed, signed, and dated by the appropriate party(ies).

  • Physical Requirements of Position/Occupational Title (Local Safety) (PDF) form You complete this form based on the usual job duties of the member’s position. Both the member and you must sign this form.
  • Physician’s Report on Disability (Local Safety) (PDF) form
    You complete sections 1 and 2 on page 1 and forward the entire form along with the job duty statement and Physical Requirement of Position/Occupational Title (Local Safety) form to a physician/medical specialist who specializes in the member’s disabling condition for completion. This form must be sent back to you along with medical records and referenced diagnostic test reports. You must use the information on the form to ensure that the member meets CalPERS criteria for DR/IDR.
  • Workers’ Compensation Carrier Request (Local Safety) (PDF) form
    You complete sections 1 and 2 on page 1 and forward the entire form to the workers’ compensation insurance carrier for completion. This form must be sent back to you after completion.

Competent Medical Opinion

A competent medical opinion must be provided by a medical specialist for the member’s or retiree’s condition. Contact CalPERS if you have questions on what qualifies as a medical specialist or competent medical opinion.

Work Restrictions

DR/IDR retirees are precluded from working in a position that includes duties or activities that the person was previously restricted from performing at the time of their retirement. Accordingly, work restrictions issued at the time the DR/IDR benefit is approved must be specified in the medical report or Physician’s Report on Disability form, directly related to the disabling condition underlying the DR/IDR and identify specific job duties that the member is unable to perform (in whole or in part) as a result of that disabling condition. Vague and ambiguous work restrictions, such as, “the member is unable to return to full duties of the position” or “the member is unable to perform the duties of the position” are not sufficient to administer post DR/IDR employment laws and could result in CalPERS not approving a retiree’s request to return to work. Accordingly, you should seek clarification when vague and ambiguous work restrictions are received.

Insufficient Documentation

If CalPERS has questions concerning the information submitted or if the documentation appears to be insufficient, we will contact you and may request additional information to resolve the questions or insufficiency prior to processing the DR/IDR benefit.


Gov. Code section 20221 of the Public Employees’ Retirement Law requires CalPERS-covered employers, including all local safety employers to furnish information concerning any member that the board may require in the administration of this system. In addition, Gov. Code section 20128 requires members or beneficiaries to provide information that the board deems necessary to determine this system’s liability with respect to, and an individual’s entitlement to, benefits administered by CalPERS.


Circular Letters

  • 200-018-17 (PDF) – Information to be included in a Resolution/Determination Document for Disability Retirement, Requirements for submitting a Disability Retirement Application, and Disability Reevaluation Procedures
  • 200-053-16 (PDF) – Requirements for Working After Disability Retirement for a CalPERS Employer
  • 200-054-19 (PDF) – Assembly Bill 672, Chapter 98 – Working After Disability/Industrial Disability Retirement



If you have any questions, contact the CalPERS Customer Contact Center at 888 CalPERS (or 888-225-7377 888-225-7377).


Keith Riddle, Chief
Disability & Survivor Benefits Division