PWGSC-TPSGC 2265 - Disability Benefit from CPP or QPP

Protected "B" when completed

Privacy notice

Provision of personal information including the social insurance number (SIN) is required pursuant to the Department of Public Works and Government Services Act, para. 7(1)(d) and s.13 and will be used for the purpose of confirming if the plan member is entitled to a Canada Pension Plan (CPP) or Quebec Pension Plan (QPP) disability benefit and administrating the Public Service Superannuation Act (PSSA). Refusal to provide the personal information or the provision of incorrect information may result in loss of benefits and/or delays in processing, incorrect pension estimates, benefits, or statements. Personal information is protected and only used and disclosed in accordance with the Privacy Act and as described in Personal Information Bank PWGSC PCU 702 - Federal Pension Administration. Under the Act, individuals have a right of access to their personal information and request correction, if erroneous or incomplete.

Note

You can fill out this form electronically and print it. Or, you can print a blank form and fill it out in dark ink using capital letters.

PWGSC-TPSGC 2265 - Disability Benefit from CPP or QPP (PDF, 967KB)

Plan member's personal information

Preferred language

To be completed by the plan member

Important

Read the instructions before completing this form. There are different types of disability benefits under the Canada Pension Plan (CPP) or Quebec Pension Plan (QPP). When selecting a checkbox, do not take into consideration if you are entitled to the CPP post-retirement disability benefit or the QPP additional amount for disability. We only need to know if you are entitled to receive the CPP or QPP disability benefit.

I declare that:

Signature of plan member

I have read and understand the instructions below.

For office use only

Instructions

You must complete this form to confirm if you are entitled to the CPP or QPP disability benefit. This allows the Pension Centre to pay your pension correctly. If you are entitled to a disability benefit from CPP or QPP and are not sure which one, contact their office

CPP or QPP disability benefit - If you retire before age 65, part of your public service pension is a temporary bridge benefit. You get the bridge until age 65. But, if you become entitled to the CPP or QPP disability benefit before that age, the bridge has to stop. This is why you must contact us right away if you become entitled to this disability benefit. You must also send us a copy of your CPP or QPP award letter.

Important: If you don’t inform us that you are entitled to the CPP or QPP disability benefit, you will continue to receive the bridge when you shouldn’t. Your public service pension will then be overpaid and you will have to repay that amount.

Other disability benefits from the CPP or QPP - You don’t need to tell us if you become entitled to either the CPP post-retirement disability benefit or the QPP additional amount for disability. These benefits don’t affect your public service pension. This means you receive the bridge benefit until age 65.

Send your completed form to us at the following address and keep a copy for your records

Government of Canada Pension Centre
Mail Facility
150 Dion Blvd
PO Box 8000
Matane QC G4W 4T6

PWGSC-TPSGC 2265 (2019-11)

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