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Fillable Printable OPM Form 1523

Fillable Printable OPM Form 1523

OPM Form 1523

OPM Form 1523

Form Approved
Supplemental Semiannual Headcount Report
OMB No. 3206-0262
1. Address of Payroll Office (including department, bureau,
location and zip code)
2. Payroll Office Number 3. Report Number
4. Date Payroll Paid
5. Pay Period
From To
6. To 7. Name of Preparer (print) 8. Telephone Number
Office of Personnel Management
ATTN: Funds Management
P.O. Box 582
Washington, D.C. 20044-0582
9. I certify that the items listed herein are correct.
Signature of authorized
official
Date
Number Enrolled
Benefit Category Dollar Amount Deductions Made No Deductions Made
A. Life Insurance
1. Basic
2. Standard - Option A
3. Additional - Option B
a. To age 35
b. 35-39
c. 40-44
d. 45-49
e. 50-54
f. 55-59
g. 60 & up
4. Family - Option C
5. Post-Retirement - Basic
6. Total Life Insurance *
B. Health Benefits
1. Regular
2. Payers of Full Premiums
3. Total Health Benefits *
* Dollar amounts must agree with SF 2812 for same reporting period.
Public Burden Statement
We estimate this form takes an average of 30 minutes to complete, including the time for reviewing instructions, getting the needed data, and reviewing the completed form. Send comments
regarding our time estimate or any other aspect of this form, including suggestions for reducing completing time, to the Office of Personnel Management, Funds Management, P.O. Box 582,
Washington, DC 20044. The OMB Number 3206-0262 is currently valid. OPM may not collect this information, and you are not required to respond, unless this number is displayed.
Office of Personnel Management This form may be locally reproduced
CSRS/FERS Handbook for Personnel and Payroll Offices Previous editions unusable
OPM Form 1523
Revised October 2014
Page 1
Supplemental Semiannual Headcount Report
Payroll Office Numbe
r
Report Number Payroll Paid Date
Benefit Category Dollar Amount
A
ggregate Base
Salary
Number Enrolled
C. Retirement
1. CSRS CPDF
Code
Deductions Made No Deductions Made
a. Regular Withholdings 1,R
b. Regular Contributions 1,R
c. Special Withholdings 6,T
d. Special Contributions 6,T
e. Regular Withholdings
for Offset Employees
C
f. Regular Contributions
for Offset Employees
C
g. Special Withholdings
for Offset Employees
E
h. Special Contributions
for Offset Employees
E
i. Salary Offset
**
j. Military Deposits
**
k. Civilian Service Credit
**
2. FERS
a. Regular Withholdings K
b. Regular Contributions K
c. Reserve Technicians
Withholdings
N
d. Reserve Technicians
Contributions
N
e. A/T Controllers
Withholdings
L
f. A/T Controllers
Contributions
L
g. Law Enforcement/Fire
-
fighters Withholdings M
h. Law Enforcement/Fire
-
fighters Contributions M
i. Salary Offset
**
j.
k. Military Deposits
**
* Dollar amounts must agree with SF 2812 for same reporting period.
** Memo entry only (do not include on line 4, Total Retirement).
OPM 1523
Revised October 2014
Page 2
Supplemental Semiannual Headcount Report
Payroll Office Numbe
r
Report Numbe
r
Payroll Paid Dat
e
Benefit Categor
y
Dollar Amoun
A
ggregate Bas
e
Salar
y
Number Enrolle
d
C. Retirement - Continued
3. FERS-RAE CPDF
Code
Deductions Mad
e
No Deductions Made
a. Regular Withholdings-RAE KR
b. Regular Contributions-RAE KR
c. Reserve Technicians
Withholdings-RAE NR
d. Reserve Technicians
Contributions-RAE NR
e. A/T Controllers
Withholdings-RAE LR
f. A/T Controllers
Contributions-RAE LR
g. Law Enforcement/Fire-
fighters Withholdings-RAE MR,OR
h. Law Enforcement/Fire-
fighters Contributions-RAE MR,OR
i. Salary Offset-RAE
**
j.
k. Military Deposits-RAE
**
4. FERS-FRAE
a. Regular Withholdings-FRAE KF
b. Regular Contributions-FRAE KF
c. Reserve Technicians
Withholdings-FRAE NF
d. Reserve Technicians
Contributions-FRAE NF
e. A/T Controllers
Withholdings-FRAE LF
f. A/T Controllers
Contributions-FRAE LF
g. Law Enforcement/Fire-
fighters Withholdings-FRAE MF,OF
h. Law Enforcement/Fire-
fighters Contributions-FRAE MF,OF
i. Salary Offset-FRAE
**
j.
k. Military Deposits-FRAE
**
5. Total Retirement*
D. Grand Total (Dollars only)
E. Total Employees (and/or Annuitants) on Payroll
* Dollar amounts must agree with SF 2812 for same reporting period. OPM 1523
** Memo entry only (do not include on line 5, Total Retirement). Revised October 2014
Page 3
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