Application for Immediate Retirement Federal Employees ...

1 CSRS/FERS Handbook for Personnel and Payroll OfficesNSN 7540-01-255-36703107-105 Application for Immediate RetirementFederal Employees Retirement SystemThis Application is for you if you are a Federal employee covered by the Federal Employees Retirement System (FERS) and you wishto apply for Retirement with an Immediate annuity. You should use this Application if you want to apply for an annuity which willbegin within 30 days of your separation from Federal not use this Application to apply for a deferred annuity. A deferred annuity begins more than 30 days after the date of finalseparation. If you want to apply for a deferred annuity, you should request an RI 92-19, FERS Application for Deferred or PostponedRetirement, from the Office of Personnel Management, Federal Employees Retirement System, Box 200, Boyers, should have received an informational pamphlet SF 3113, applying for Immediate Retirement under the Federal EmployeesRetirement System, with this Application .

2 If you did not receive the pamphlet you should get a copy from your employing benefits and Retirement processing are complicated. Read the information in the pamphlet carefully. When you decide toretire, give your agency advance notice so it can be sure your records are complete and it can carry out its responsibilities inprocessing the paperwork associated with your your completed Application to the personnel office of your employing agency. They will forward your Application to the Officeof Personnel Management for processing. If you have any questions, ask your employing office for assistance. You must applyseparately for any benefits payable from the Thrift Savings Plan and the Social Security your address changes after your Application has been forwarded to the Office of Personnel Management, but before you receiveyour claim number, write to us, giving your name, date of birth, and Social Security Number.

3 If you have received your claim number,remember to refer to for Completing ApplicationType or print clearly. If you need more space in any section,use a plain piece of paper with your name, date of birth, andSocial Security Number written at the top. If you do not knowan answer write "unknown". If you are unsure of information(for example, if you do not know an exact date), answer tothe best of your ability, followed by a question mark (?).The following additional information should help you toanswer those questions on the Application which are notentirely A - Identifying InformationItem 2:List other names under which you have beenemployed in the Federal government (such as amaiden name). This will help us to locate and identify records maintained under these 3:Enter the address to which correspondenceshould be mailed. If you want your paymentssent to a bank, do not enter the bank addresshere; see Section H of the Application 4:Give a telephone number where you can bereached after you retire and the best time toreach you during business B - Federal ServiceItem 2:Enter the date of final separation for Retirement .

4 (Leave blank if applying for disability retirementand not separated.)Item 4:Indicate whether or not you have performedactive duty that terminated under honorable conditions in the armed services or otheruniformed services of the United States includingthe following:a. Army, Navy, Marine Corps, Air Force or Coast Guard of United States;b. Commissioned Corps of the Public Health Service after June 30, 1960;c. Commissioned Corps of the National Oceanicand Atmospheric Administration (formerlyCoast and Geodetic Survey and EnvironmentalScience Services Administration) after June30, 1961;d. Cadet or Midshipman of the Military Academy, Air Force Academy, Guard Academy, or in reserve components and/or the NationalGuard is not considered active Federal militaryservice except when ordered to active duty in the service of the United States and during an initial4-month training period for Guardsmen. However,full time National Guard duty (as such term is defined in Section 101(d) of title 10) is creditable,if such service interrupts FERS creditable civilianservice and is followed by reemployment in accordance with Chapter 43 of title 38 that occursafter August 1, editions are not Form 3107 Revised April 2000 For Army, Navy, Air Force, and Marine Corpsretired pay verifications: DFASC leveland CenterRetired Pay Box 99191 Cleveland, OH 44199-1126 For Coast Guard retired pay verification:Commanding Officer (RAS)USCG Pay and Personnel Center444 SE Quincy StreetTopeka, KS 66683-3591If you are waiving military retired pay for FERS Retirement purposes, your agency can help youprepare your request for waiver.

5 Attaching a copyof your waiver request and the finance center'sacknowledgment (if available) to your applicationmay help us to process your claim more quickly.(Even if you have already waived your militaryretired pay to receive benefits from the VeteransAdministration, you also need to file a waiver forFERS.)SECTION C - Marital InformationItem 2:Indicate whether you have a living former spouseto whom a court order awards a survivor annuitybased on your Federal employment. If you answer"yes," you must submit a certified copy of thecourt order and any attachments or D - Annuity Election(See pages 11-18 of SF 3113, applying for ImmediateRetirement under the Federal Employees RetirementSystem.)Read the information about survivor benefits found in thepamphlet, applying for Immediate Retirement under FERS,before completing Section 4:If you initial Box 4, a person selected by you,who has an insurable interest in you, will receivea survivor annuity upon your death.

6 Insurable interest exists if the person named may reason-ably expect to derive financial benefit from yourcontinued life (such as a former spouse or a closerelative).If you choose an insurable interest survivor annu-ity, the survivor annuity will be 55 percent ofyour annuity after your annuity has been reducedto provide this benefit (see table).Any employee who is not retiring for disabilityand who can prove good health may elect areduced annuity to provide a survivor annuity fora person having an insurable interest in you have performed such service, complete andattach Schedule A, furnishing the requested infor-mation for each period of active receive FERS credit for military service per-formed on or after January 1, 1957, you mustmake a deposit of 3 percent of your military basicpay. You must pay the deposit to your agencywhile you are still employed. You may not payOPM after you you are entitled to have part of your retirementcomputed under CSRS rules, military service per-formed prior to your transfer to FERS comesunder CSRS deposit rules.

7 These rules are asfollows: The CSRS deposit is 7 percent of yourmilitary basic pay. If you were first employed in a civilianposition before October 1, 1982, you do notpay the deposit and you are eligible for aSocial Security benefit at age 62, the CSRS part of your annuity will be recomputed at age62 to delete credit for the post-1956 militaryservice. If you were first hired on or after October 1,1982, you will not receive any credit forpost-1956 military service if you do not makethe deposit for it. CSRS military service deposits must also bepaid to your agency while you are 5:If you are receiving, or have applied for, militaryretired pay, answer "yes" to Item 5, then com-plete and attach Schedule B-Military Retired Pay.(Note: Military retired pay includes disabilitypay.)This information is needed to assure correctcredit for military service. Receipt of military retired pay may affect the computation of your annuity you are receiving military retired pay awardedfor: reserve service under Chapter 1223, title 10, Code (formerly Chapter 67, title 10); or a disability incurred in enemy combat orcaused by an instrumentality of war in the lineof duty during a period of war as defined inChapter II, title 38, Code, attach a copy of the notice of the award to this you do not have this documentation, you canrequest verification of the type of award from:Standard Form 3107 Revised April 20003 You may elect this insurable interest survivor annuity in addition to a regular survivorannuity for a current or former spouse.

8 If youelect an insurable interest annuity for your cur-rent spouse, you must both jointly waive the cur-rent spouse annuity. Generally, an insurableinterest cannot be cancelled. However, if you elect the insurable interest annuity for a currentspouse because a court order awards (or you haveelected) the regular survivor annuity to a formerspouse, the insurable interest election for your current spouse can be converted to a current spouse annuity if the former spouse loses entitle-ment to the regular you choose an insurable interest annuity, theamount of the reduction in your annuity willdepend upon the difference between your age andthe age of the person named as survivor annuitant,as shown in the table of the Person Named in Relationto That of Retiring EmployeeReductionin Annuityof RetiringEmployeeOlder, same age, or less than 5 yearsyounger5 but less than 10 years younger10 but less than 15 years younger15 but less than 20 years younger20 but less than 25 years younger25 but less than 30 years younger30 or more years younger10%15%20%25%30%35%40%Box 5.

9 If you initial box 5, your former spouse(s) willreceive a survivor annuity upon your death. Themaximum survivor annuity payable to your for-mer spouse(s) is 50% of your unreduced annuity will be reduced 5% or 10% accord-ing to the total benefit you want to may elect to provide a survivor annuity formore than one former spouse. The total of the survivor annuities must equal either 25% or 50%of your unreduced you are married, you must have your spouse'sconsent to choose this option, because any bene-fit elected for a former spouse limits what can beelected for your current spouse. (Complete and attach SF 3107-2, Spouse's Consent to Survivor Election, to your Application .) The maximum combined survivor benefits that can be electedfor your current and former spouse(s) is 50% ofyour Form 3107 Revised April 2000 SECTION F - Other Claim InformationItem 1:If you have applied for, or received, workers' compensation from the Office of Workers' Compensation Programs, Department ofLabor, because of a job-related illness or injury,check the "yes" box and complete Schedule Schedule C you should provide the followinginformation:1.

10 If you are receiving (or have received in thelast 2 years) compensation, enter your com- pensation claim number(s), the beginningand ending dates of each period for which compensation was paid, and whether the benefits were a scheduled award or If you have applied for, but are not receivingbenefits, indicate whether your claim is pend-ing or has been denied and the claim Indicate whether you agree to notify us if thestatus of your workers' compensation claim changes and whether or not you authorize theOffice of Personnel Management and/or the Office of Workers' Compensation Programs tocollect any overpayment if we find that youwere paid, but not eligible for, both compen-sation and annuity benefits covering the sameperiod of time. Without this authorization, wewill not authorize payment of your annuityuntil we can confirm that OWCP is not paying you information requested regarding benefitsfrom the Office of Workers' Compensation Programs is needed because the law prohibitsthe dual compensation which would exist ifyou received both a FERS annuity and compensation for total or partial disabilityunder the Federal Employees ' G - Information About ChildrenComplete Section G by providing the names and dates ofbirth of your unmarried dependent children under the age of18.