Transcription of Application to Make Deposit or Redeposit
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Not Withheld Check whether deductions were not withheld,withheld and refunded, orwithheld and remain to your creditTitle of PositionApplication to make Deposit or RedepositCivil Service Retirement SystemForm ApprovedOMB No. 3206-0134 Civill ServiceRetirement SystemTo avoid a delay in processing your claim:1. Read the attached information Type or print in Complete Part A in full. If you are currently a Federal employee, have your employing agency complete Part A. To be Completed by the ApplicantStandard Form 2803 Revised June 2013 Previous editions are not Office of Personnel ManagementCSRS/FERS Handbook for Personnel and Payroll OfficesDepartment or Agency(including bureau, branch or divisionwhere employed) Location of Employment(city and state) Periods of ServiceBeginning Date(mm/dd/yyyy)Ending Date(mm/dd/yyyy)1.
Information Regarding Deposit and Redeposit Civil Service Retirement System Detach this information sheet before filling out the application. Read this information carefully before filling out the attached application.
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