Human Resources (HR)


Standard Operating Procedures


Short-Term Reimbursement and
Granting Service Credits

Original Effective Date:


Revised Effective Date:






Note: The Short-Term Reimbursement and Granting Service Credits procedure, forms and instructions are listed in the Retirement Section, pages 155-158 of the Retirement Employer Manual.





1.       For appropriate service credits to be granted and to apply for reimbursement in cases where payment extends beyond six months, the following forms must be submitted to the Retirement System, 325 N. Salisbury St. Raleigh, NC 27603-1385:


Form DIP-E4, “Employer Request to Grant Service Credits and/or for Reimbursement of Payments Made Under the Plan”  (sample Form on pages 178-179, Retirement Employer Manual)


Form DIP -1, “Application for Short Term Disability Benefits”


Form DIP- 3,”Employee Request for Payment and Certification of Disability by Physician” (signed and dated by the physician covering the period for which service credits and/or reimbursement is requested)


Form DIP-E1, “Employer Master Worksheet for Determining Eligibility for Short Term Benefits”


2.       If the disability lasted less than six months, the above forms should be filed immediately after the disability ends.


3.       If payment extends beyond the first six months, the above forms may be submitted at the conclusion of the short-term disability period or upon termination of short-term disability, if earlier, to grant service credits and request reimbursement.