Please complete every question so that you will not experience delays in filing for benefits. Please do not file multiple applications for the same illness/injury as this will also delay processing your claim.
Print and complete the application form. Attach the direct deposit form (if you choose that option) and mail to:
Temporary Disability Insurance
P.O. Box 20100, Cranston, RI 02920-0941
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DLT is an equal opportunity employer/program - auxiliary aids and services available upon request. TTY via RI Relay: 711