TEMPORARY DISABILITY / CAREGIVERS INSURANCE, Rhode Island Department of Labor and Training with DLT logo and state seal

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Application for TDI/TCI Benefits Form

 

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.


Download a Paper Application


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



We have eliminated the payment of TDI benefits by paper checks. You have two different benefit payment options; Direct Deposit or Electronic Payment Card (EPC) (similar to a debit card).

  • If you select the Direct Deposit method, please complete the direct deposit form and mail it with your TDI application to the address above.
  • If you select the Electronic Payment Card (EPC), do not send in a direct deposit form. The EPC card will arrive in the mail in a plain white envelope. Please be sure to read the instructions to avoid any ATM or bank charges. Visit the TDI EPC website for more information.

 

 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



 

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5/21/19 MDF