Transcription of Application to Make Deposit or Redeposit
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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) Periods of ServiceBeginning Date(mm/dd/yyyy)Ending Date(mm/dd/yyyy)1.
The information you furnish will be used to determine your eligibility to make deposits or redeposits to the Civil Service Retirement and Disability Fund, to identify records properly associated with your application, to obtain additional information if necessary, and to maintain a uniquely identifiable claim file.
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