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Application to Make Deposit or Redeposit

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)

Not Withheld whether deductions were not withheld,Check withheld and refunded, or withheld and remain to your credit Title of Position Application to Make Deposit or Redeposit

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