Instituto Nacional do Seguro Social (INSS) Edition Current gov.br/inss 'editável' file (no edition date printed; PDF of 22 March 2021) 1 page

INSS — Requerimento de Benefício por Incapacidade (Incapacity Benefit Claim)

The INSS paper claim for the temporary incapacity benefit, with the employer's work-absence certificate on the same page.

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INSS incapacity benefit claim · Requerimento de Benefício por Incapacidade
The official Instituto Nacional do Seguro Social (INSS) form, edition Current gov.br/inss 'editável' file (no edition date printed; PDF of 22 March 2021) — blank
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INSS incapacity benefit claim (2026) Requerimento de Benefício por Incapacidade — page 1 of 1
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Fill this form online Blank PDF from Instituto Nacional do Seguro Social (INSS)

What is INSS incapacity benefit claim?

When an insured worker in Brazil can't work because of illness or an accident, the INSS pays a benefit for temporary incapacity (benefício por incapacidade temporária, still widely called auxílio-doença). Most claims are made through Meu INSS or the 135 phone line, but the INSS still publishes this one-page paper claim for filing at an INSS agency.

The page has three parts. The insured person gives their personal details, address, registration document, marital status and whether they have another activity covered by social security. An attorney or guardian claiming for them adds their name and address. For employees, the company fills in the 'Atestado de afastamento do trabalho' — its CNPJ and address, the employee's last day of work and whether the absence is due to illness, an accident at work or arose during holidays — and lists the children for whom it pays salário-família, then signs and stamps it.

FileIt explains each box in English, checks the CNPJ and dates, and places your answers on the INSS PDF so that accented and non-Portuguese names print correctly. The finished form is kept in your vault. FileIt never sends anything to the INSS.

Issued by
Instituto Nacional do Seguro Social (INSS)
Who fills it
The insured person; for employees, the employer completes the work-absence certificate
Other ways to claim
Meu INSS (app or website) or the 135 phone line
Signatures
The insured person signs; the employer signs and stamps its certificate by hand
Edition
Current gov.br 'editável' file (no date printed)
Pages
1

Who needs to fill out INSS incapacity benefit claim?

  • Employees who are off work because of illness or an accident and are claiming the INSS incapacity benefit at an agency.
  • Self-employed and other insured people claiming the same benefit on paper (they leave the employer certificate blank).
  • An attorney or court-appointed guardian claiming on behalf of an insured person.
  • Employers asked to complete the work-absence certificate for an employee's claim.

When to use INSS incapacity benefit claim

  • When you are making the incapacity claim in person at an INSS agency rather than through Meu INSS or 135.
  • When the INSS asks for the paper claim or the employer's work-absence certificate.
  • When the employee receives salário-família and the children need to be listed for the benefit period.

What you need before you start

  • The insured person's full name, date of birth, nationality and full address with CEP.
  • The registration document number — usually the NIT / PIS / PASEP, or the work card (CTPS) number and series.
  • Details of the attorney or guardian, if someone claims on your behalf.
  • For employees: the company's name, CNPJ and address, and the last day of work.
  • The first names and dates of birth of the children for salário-família, if any.
  • Your medical certificates and reports, which you take to the INSS medical examination.

What’s on INSS incapacity benefit claim

The 2026 edition has 1 page. FileIt asks for it in 4 parts, and it is signed by Insured person (segurado/a):

  1. Insured person (segurado/a)Insured person (segurado/a)
  2. Attorney or guardian (procurador ou curador)Insured person (segurado/a)
  3. Work-absence certificate (atestado de afastamento do trabalho)Employer (empresa)
  4. Children for salário-família (dependentes para salário-família)Employer (empresa)

How to fill out INSS incapacity benefit claim, step by step

1 Insured person

Name, date of birth, nationality, address, sex, registration document, marital status, and whether you have another activity linked to social security.

2 Attorney or guardian

Only if a procurador or curador claims for you: their name and address.

3 Work-absence certificate

Filled by the employer: company name, CNPJ, address, the employee's last day of work and the cause of the absence — illness, accident at work or holidays.

4 Children for salário-família

Up to eight children's first names and dates of birth, then the place and date. The employer signs and stamps the certificate.

5 Signature

The insured person signs on the 'Assinatura' line under the personal details.

Common mistakes to avoid

  • Leaving the employer certificate blank when you are an employee — the form says the company is responsible for it.
  • Giving a registration number that doesn't match your INSS record.
  • Forgetting to say you have another activity covered by social security.
  • Listing children for salário-família without their dates of birth.
  • Coming to the agency without the medical certificates and reports for the examination.

After you fill it out

Print the form and have the employer complete, sign and stamp its certificate if you are an employee.

Sign it and take it, with your documents and medical reports, to the INSS agency as the INSS tells you when you book through Meu INSS or 135.

Keep the copy FileIt saves in your vault with the INSS's reply.

Fill out INSS incapacity benefit claim online with FileIt

  1. Pick the person. Choose someone from People and FileIt fills in their name, date of birth, address and other details it already knows.
  2. Answer plain-language questions. One part of the form at a time, with the official help text beside each question — 45 fields in all. Your answers save as you go.
  3. Check the live preview. Watch your answers land on the real Instituto Nacional do Seguro Social (INSS) form, and let FileIt do any worksheet arithmetic.
  4. Generate the official PDF. FileIt prints your answers into the agency’s own PDF and files it in that person’s folder in your vault. Sign it, or send it for e-signature.

FileIt fills the form — it never files or submits anything for you. Deliver the finished form to whoever asked for it, the way the form’s instructions say.

Start INSS incapacity benefit claim now — it’s free

INSS incapacity benefit claim: frequently asked questions

Is this the same as auxílio-doença?

Yes. Since the 2019 reform the benefit is officially called benefício por incapacidade temporária, but many people and documents still say auxílio-doença.

Do I have to use this paper form?

No. The INSS's main channels are Meu INSS and the 135 phone line. The paper form is for filing at an agency.

I'm self-employed. What do I do with the employer part?

Leave it out. The work-absence certificate is for employees; FileIt lets you switch it off.

Can I sign it electronically?

FileIt offers an electronic signature for the insured person, as the form doesn't ask for ink. The employer's part needs the company's signature and stamp, so FileIt leaves that for signing by hand.

Official sources

FileIt is not affiliated with or endorsed by Instituto Nacional do Seguro Social (INSS) or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-25.

Fill out INSS incapacity benefit claim online