ORDER OF SOCIAL INSURANCE FUND OF THE RUSSIAN FEDERATION

of September 17, 2012 No. 335

About approval of the document forms applied to payment in 2012 and 2013 of insurance coverage and other payments in the subjects of the Russian Federation participating in realization of the pilot project providing appointment and payment to insured persons of insurance coverage for compulsory social insurance to case of temporary disability both in connection with motherhood and on compulsory social insurance from labor accidents and occupational diseases, other payments and expenses by territorial authorities of Social Insurance Fund of the Russian Federation

According to Items 2, 3, 6, 7, 8, 10, 11, 12, 14 Regulations on features of appointment and payment in 2012 and 2013 to insured persons of insurance coverage for compulsory social insurance on case of temporary disability and in connection with motherhood and other payments in the subjects of the Russian Federation participating in realization of pilot project, Items 2, of 3, of 6, of 11, 13 Regulations on features of appointment and payment in 2012 and 2013 to insured persons of temporary disability benefit in connection with labor accident or occupational disease and also leave allowance of insured person (over the annual paid leave established by the legislation of the Russian Federation) for the entire period of treatment and journey to the place of treatment and back, in the subjects of the Russian Federation participating in realization of pilot project approved by the order of the Government of the Russian Federation of April 21, 2011 N 294 (The Russian Federation Code, 2011, N 18, Art. 2633; 2012, N 1, to the Art. 100), I order:

1. Approve:

the application form about allowance payment (leave allowance) according to the appendix N 1;

form of the inventory of the statements and documents necessary for appointment and payment to insured persons of the corresponding types of benefits, according to the appendix N 2;

the application form about expense recovery for allowance payment on temporary disability according to the appendix N 3;

form of the notice on submission of missing documents or data according to the appendix N 4;

form of the decision on refusal in appointment and allowance payment on temporary disability according to the appendix N 5;

the application form about expense recovery for payment of social benefit for burial according to the appendix N 6;

the application form about expense recovery for payment of four additional days off to one of parents (the guardian, the custodian) for care of handicapped children according to the appendix N 7;

the application form about cost recovery of the guaranteed list of services in burial according to the appendix N 8;

form of the decision on refusal in consideration of documents (data) according to the appendix N 9;

form of the reference calculation of the amount of leave allowance (over annually paid leave) for the entire period of treatment and journey to the place of treatment and back according to the appendix N 10.

2. Declare invalid the order of Social Insurance Fund of the Russian Federation of June 17, 2011 N 195 "About approval of the document forms applied to payment in 2011 of insurance coverage and other payments in the subjects of the Russian Federation participating in realization of the pilot project providing appointment and payment to insured persons of insurance coverage for compulsory social insurance to case of temporary disability both in connection with motherhood and on compulsory social insurance from labor accidents and occupational diseases, other payments and expenses by territorial authorities of Social Insurance Fund of the Russian Federation" (it is registered by the Ministry of Justice of the Russian Federation on July 4, 2011 N 21256).

 

Appendix №1

to the order of Social Insurance Fund of the Russian Federation of 17.09.2012 No. 335

The application form about allowance payment (leave allowance)

see the Application form about allowance payment (leave allowance) (12Kb In original language)

 

Appendix № 2

to the order of Social Insurance Fund of the Russian Federation of 17.09.2012 No. 335

Form of the inventory of the statements and documents necessary for appointment and payment to insured persons of the corresponding types of benefits

see the Form of the inventory of the statements and documents necessary for appointment and payment to insured persons of the corresponding types of benefits   (7Kb In original language)

Appendix №. 3

to the order of Social Insurance Fund of the Russian Federation of 17.09.2012 No. 335

The application form about expense recovery for allowance payment on temporary disability

see the Application form about expense recovery for allowance payment on temporary disability   (8Kb In original language)

Appendix №4

to the order of Social Insurance Fund of the Russian Federation of 17.09.2012 No. 335

Form of the notice on submission of missing documents or data

 

<*> Insurer __________________________________________________________

                     (full name of the organization (isolated

                         divisions), First name, middle initial, last name physical person)

 

Registration number ___________________/_______________________________

Subordination code _________________________________________________________

INN ____________________________ ______________________________________ CHECK POINT

 Location address   of the organization  (separate division)/address

permanent residence of _____________________________ physical person

___________________________________________________________________________

<**> Applicant ____________________________________________________________

                                          (Surname, name, patronymic)

Data on the identity document _____________________________

___________________________________________________________________________

   (document type, proving the identity, series and document number,

                  who issues the document, date of its issue)

Place of residence _______________________________________________

___________________________________________________________________________

   (postal index, name of the residential or rural location,

    streets, house numbers, cases, apartments, phone (with indication of code))

 

                                Notice

           about submission of missing documents or data

                        from __________ N _________

 

    Based on Item 7 of the Regulations on features of appointment and payment in

  2012 and 2013      to insured persons of insurance coverage on

to compulsory    social    insurance    on   case   temporary

disability and  in connection with   motherhood and other payments in subjects

The Russian Federation, participating in realization of pilot project, and Items

6 and 13 Regulations on features of appointment and payment in 2012 and 2013

to insured persons  of temporary disability benefit   in connection with

 labor accident   or occupational disease, and

also  leave allowance of insured person (over annual paid

the leave established by the legislation of the Russian Federation) on all

the period of treatment and journey to the place of treatment and back, in subjects Russian

Federations,  participating  in realization of pilot project, approved

 the order of the Government of the Russian Federation    of April 21, 2011.

N 294, needs to be provided in ___________________________________________

___________________________________________________________________________

   (name of territorial authority of Social Insurance Fund

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