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VETERAN’S AUTHORIZATION FOR DISABILITY RECORD INSTRUCTIONS TO VETERAN: Complete PART A. Send this form to the Veterans Benefits Administration Regional Office where your disability claim is on file. The Regional Office will then complete PART B and return to the address above. Please refer to following page regarding an update to the process of claiming and/or using veteran credits. PART A (To be completed by Disabled Veteran) EXAMINATION TITLE: EXAM NUMBER: APPLICANT'S NAME: SOC. SEC. NO.: - - Last Name First Name M.I. MAILING ADDRESS: Post Office Box or Street Address City State Zip Code LEGAL RESIDENCE: Street Address City State Zip Code V.A. CLAIM NUMBER: SERVICE SERIAL NUMBER: I hereby authorize the Veterans Benefits Administration Regional Office to furnish the Cayuga County Civil Service Commission with the data requested in PART B below pertaining to my disability status. The Regional Office is released from all liability in complying with this request. It is understood that all information furnished will be treated as confidential. X Signature of Veteran Date Signed PART B (To be completed by Veterans Benefits Administration Regional Office) REGIONAL OFFICE: CLAIM NUMBER: 1. Does the above-named veteran now have a war-incurred disability? YES NO If YES, please enter date disability was sustained: / / 2. Percentage of such disability now in existence: % 3. Describe the disability: 4. Date of last medical examination by V.A. Medical Officer in connection with such disability: / / (If less than one year ago, do not answer questions 5 and 5. Does the V.A. state affirmatively that a permanent stabilized condition of disability exists to an extent of 10% or more, even though the veteran has not been examined by the V.A. Medical Officer within one year? YES NO 6. Date of next scheduled examination by the V.A.: / / 7. Additional remarks: X Signature of Adjudication Officer Date Signed Department of Human Resources and Civil Service Commission County Office Building, 2nd Floor, 160 Genesee Street, Auburn, NY 13021 Website: www.cayugacounty.us/civilservice Telephone: (315) 253-1284 ---PAGE BREAK--- AMENDMENT TO NEW YORK STATE CONSTITUTION REGARDING VETERAN CREDITS UPDATE: Effective January 1, 2014, an amendment to Article V, Section 6 of the New York State Constitution allows certain disabled veterans to use additional credits on civil service exams to obtain a second appointment or promotion. Previously, the New York State Constitution had provided a strict one-time-only use of veteran credits on a civil service examination. A non-disabled war-time veteran was entitled to a one-time use of either 5 points on an open-competitive examination or 2.5 points on a promotional examination. A disabled war-time veteran was entitled to a one-time use of either 10 points on an open-competitive examination or 5 points on a promotional examination. IMPACT OF THE NEW AMENDMENT: The amendment creates an exception to the one-time-only use of veteran credits. It permits veterans who are certified as disabled after having already received credits at either an original appointment or a promotion because of their status as non-disabled veterans to receive additional credits after the certification of their disability. After being certified disabled, such a veteran would be entitled to an additional grant of credits equal to the difference between 10 credits and the number of credits received at the initial appointment or promotion. This would bring the total additional points of Civil Service credits such a veteran can receive to 10 for either an appointment or a promotion. If a veteran previously received 5 (non-disabled) points on an open-competitive examination and subsequently became certified as disabled, he or she would be entitled to receive another 5 (disabled) points on a subsequent examination whether an open-competitive or a promotional examination. If a veteran previously received 2.5 (non-disabled) points on a promotional examination and subsequently became certified as disabled, he or she would be entitled to receive another 7.5 (disabled) points on a subsequent examination whether an open-competitive or a promotional examination. There is no change for a veteran who has already received non-disabled veteran credits and remains non-disabled. A disabled veteran who received disabled veteran credits without previously having received non- disabled veteran credits is not entitled to any additional credits. z:civil\APPLICATION SUPPLEMENTAL FORMS\Veteran Authorization for Disability Record