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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. Name (Last, first, middle)2. List other names you have used5.

List below in chronological order all periods of Federal civilian service. Be sure all your service is listed so that the Office of Personnel Management (OPM) can bill you for the correct amount. Civilian Service (Complete item 10) Military Service (Go to item 11) 9 3. 8. Title of position 9b. Claim number(s) [if available] Birthdate (mm/dd ...

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  Applications, Make, Order, Deposits, Chronological, Application to make deposit or redeposit, Redeposit, Chronological order

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