State law requires each DIPNC long-term disability benefit recipient to complete and submit a Statement of Income form to report earnings from employment and/or benefits from certain other sources each year to the Retirement Systems Division. This form is mailed annually to each plan recipient. The plan may require other statements of monthly earnings as necessary. If you exceed the monthly allowable earnings limitations, you must notify the plan of the amount of the excess monthly earnings by the fifth of the month after the month in which the earnings were received. Failure to report excess monthly earnings may result in a suspension or termination of your DIPNC benefit and State Health Plan coverage.