Line of Duty Death/Non-Line of Duty Death Assistance Request Form

Financial assistance is provided to the families of public safety officers and firefighters upon death; aid is also extended to officers and firefighters who are called to active duty military. Assistance is extended to volunteer and/or reserve officers/firefighters only when the incident occurs while he/she is on duty. To request assistance for a public safety officer or firefighter, the appropriate form must be completed by a supervisor or by human resource personnel. Potential beneficiaries are not authorized to submit requests. If you have questions, please feel free to call our office at (602) 975-2527.

Please use the links to the right to fill out the appropriate request form. If you are not contacted by a 100 Club of Arizona representative within 24 hours after submitting your request, please call our office at (602) 975-2527 to verify that your paperwork has been received.

WE OFFER ASSISTANCE IN CASE OF:

 LINE OF DUTY DEATH (LODD)   $20,000 one-time assistance

 ON DUTY DEATH (ODD)   $15,000 one-time assistance

 NON-LINE OF DUTY DEATH (NLODD)   $10,000 one-time assistance

RETIREE DEATH (NLODD) $1,000 one-time assistance 

*When a death occurs within 10 years of the PSPRS retirement date and not past the age of 65. The past department will submit.