To avoid delays in receiving benefits, please check the following items carefully before submitting
your application:

Form 6352
Revised 11/22/2022
Page 1 of 2

RETIRING MEMBER'S DISABILITY APPLICATION CHECKLIST

SC Public Employee Benefit Authority

202 Arbor Lake Drive

Columbia, SC 29223

Application is submitted while you are a member in service with a participating employer.

Only one method of payment is selected in Section II.

No corrections or white-outs are made on the application.

One or more beneficiaries are designated in Sections II and III.

Payroll status is indicated in Section IV.

Application is signed.

A copy of your birth certificate (or other proof of birth if a public birth certificate does not exist) is attached.

If you selected a joint retiree-survivor payment plan, a copy of a birth certificate (or other acceptable proof of birth if a public birth certificate does not exist) for each beneficiary is attached.

(PORS ONLY) Disability Report (Form 6251) is completed in full, signed, dated, and attached.

(PORS ONLY ) One Authorization for Release of Information to Disability Determination Service (Form 6255) is signed and attached. This form must be dated. Do not have medical records forwarded directly to the South Carolina Retirement Systems by your treating physician or other health care provider.

Direct Deposit Authorization (Form 7204) is completed and returned to the Benefit Payments

Department at the SC Public Employee Benefit Authority (PEBA). Monthly annuity payments are distributed the last business day of each month by direct deposit.

Service and installment purchases should be paid in full prior to anticipated retirement date.

NOTE: If you are approved for disability retirement benefits, the PEBA will request a certification of the last day you earned compensation or expect to earn compensation from your employer.  

A copy of your current driver's license or state-issued identification card is attached.

THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS AND DOES NOT CREATE A CONTRACT BETWEEN THE MEMBER AND THE SC PUBLIC EMPLOYEE BENEFIT AUTHORITY. THE SC PUBLIC EMPLOYEE BENEFIT AUTHORITY RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS DOCUMENT. 

Please contact PEBA's Customer Services department with any questions: 803-737-6800, 800-868-9002 (within S.C. only), or www.retirement.sc.gov.

RETIREE HEALTH INSURANCE - Eligibility to receive retirement benefits does not necessarily constitute eligibility to receive retiree health insurance coverage. Prior to selecting your retirement date and leaving employment, you should contact your employer and health insurance provider to determine if you will be eligible for health insurance coverage after your retirement. If your health insurance is provided by PEBA Insurance Benefits, please contact Customer Services to determine your eligibility for retiree health insurance coverage.

(PORS ONLY) Job Description (Form 6254) has been given to your employer to complete.

Disability Employment Status Report (Form 6253) has been given to your employer to complete.

Withholding Certificate for Monthly Benefit Payments (Form 7202) is completed and returned to the Benefit Payments Department at PEBA in order to specify South Carolina state tax withholding. If you do not complete a Form W4-P, no South Carolina state tax will be withheld.

Form W-4P (www.irs.gov/fw4p) is completed and returned to the Benefit Payments Department at PEBA in order to specify federal tax withholding. If you do not complete a Form W4-P, your default federal tax withholding rate will be single with zero exemptions.