93 - Arbeitsunfähigkeitsbescheinigung (Kopie)

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Welcome to the online service of the Jobcenter Landkreis Ansbach

You can inform us about your current incapacity to work through this form.

Please note the following:

Please fill out the form completely. It will be necessary to submit a copy of your medical certificate/certificate of incapacity for work.

The completed form will then be transmitted digitally and securely to the Jobcenter Landkreis Ansbach.

You can find our information on the processing of your data here (below Jobcenter).

Bürgergeld - Incapacity to work

Submission of a medical certificate during the receipt of Unemployment Benefit II/Social Assistance under the Social Code Book II (SGB II)

Personal information

Last name*

First name*

Date of birth*

Number of benefit community*

Incapacity to work

Is this a first-time medical certificate or has an existing one been extended?*

First-time medical certificate

Extension of a medical certificate

Incapable to work since*

Presumably incapable to work until*

Please upload your medical certificate for work*

Information:

It is still neccesary to submit a medical certificate to the Jobcenter Landkreis Ansbach as the automatic submission has only been implemented yet for employers of an ongoing employment.

Your consent

I confirm that the information I have provided is correct and complete.*

I have taken note of the general Privacy Policy in accordance with Article 13 GDPR and the Specific Privacy Policy for the Jobcenter.*

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