Benefits provide financial assistance to the families of public safety officers and firefighters upon death or serious injury,* and are extended to officers and firefighters when called to active duty military. Direct family benefits are currently $15,000 for line of duty death, $5,000 for non-line of duty death, and up to $18,000 for line of duty injury cases.
*Benefits are extended to volunteer and/or reserve officers/firefighters only when the incident occurs while s/he 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. For benefit questions contact pattib@100club.org.
Line of Duty Death / Non-Line of Duty Death Benefit Request Form
Download (PDF) Version
Line of Duty Injury Benefit Request Form #1 Please use this form when submitting your first request for Line of Duty Injury benefits
Download (PDF) Version
Line of Duty Injury Benefit Request Form Continuing (for requests #2-12)
Download (PDF) Version
Heroes/Special Needs Request Form Please complete this form if suggested by a 100 Club representative
Download (PDF) Version
If you are not contacted by a 100 Club of Arizona representative within 24 hours after submitting your request, please call the 100 Club of Arizona office at (602) 485-0100 to verify that your paperwork has been received.