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Fillable Printable SF 2803

Fillable Printable SF 2803

SF 2803

SF 2803

Not Withheld
Check whether deductions were not withheld,
withheld and refunded, or
withheld and remain to your credit
Title of Position
Application to Make Deposit or Redeposit
Civil Service Retirement System
Form Approved
OMB No. 3206-0134
Civill Service
Retirement System
To avoid a delay in processing your claim:
1. Read the attached information carefully.
2. Type or print in ink.
3. Complete Part A in full. If you are currently a Federal employee, have your employing agency complete Part B.
Part A. To be Completed by the Applicant
Standard Form 2803
Revised June 2013
Previous editions are not usable.
U.S. Office of Personnel Management
CSRS/FERS Handbook for Personnel and Payroll Offices
Department or Agency
(including bureau, branch or division
where employed)
Location of Employment
(city and state)
Periods of Service
Beginning Date
(mm/dd/yyyy)
Ending Date
(mm/dd/yyyy)
1. Name (Last, first, middle)
2. List other names you have used
5. Department or agency in which presently or last employed, including
bureau, branch, or division
4.
7. Location of employment (city and state)
9. Have you previously filed any application under the Civil Service Retirement System (CSRS)?
9a. Type of application
10. I am applying to make a service credit payment for:
11. Are deductions for the Civil Service Retirement System now being withheld from your salary?
12.
Give the date of separation from your last position under the
Civil Service Retirement System
Date of separation
(mm/dd/yyyy)
13. Signature of applicant
15. Telephone number (including area code) where you can be
reached during the day
16.Date (mm/dd/yyyy)
Yes, complete items 9a and 9b
No
Voluntary Contributions Account
Service credit payment
Retirement
Refund
Yes (Go to item 13)
No (Go to item 12)
Address (Number and street)
( )
Put a check mark ( )
in the boxes below, next to
the periods of service you
want to pay for. (If you do
not want to pay for a
specific period of service,
leave the box blank.)
Withheld and
Refunded
Withheld and
Not Refunded
(City, state and ZIP Code)
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/yyyy)
Social Security Number6.
14.Email address
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Part B. To Be Completed by the Employing Agency
Instructions to the Agency - This application is not to be used as a means for verifying service for leave, retention or other non-retirement purposes.
The procedures for verifying service for establishing creditability of service are contained in Chapter 20 of the CSRS/FERS Handbook. If more space is
needed for information requested in Item 3, please attach a separate sheet. Show the name and Social Security Number of the applicant on the separate sheet
(SF 2801-1 may be used for this purpose).
No Yes
1. Is the employee in a position subject to civil service retirement coverage? 2. Exact date civil service retirement deductions began for the current appointment
(mm/dd/yyyy)
3.
Civilian Service Not Under a Retirement System for Federal Employees
From verified service documented in official personnel records, list any Federal civilian service not subject to a retirement system for Federal (or D.C.
Government) employees. If total basic salary earned for any such period is known, a summary entry may be entered on the right-hand side below.
Otherwise, show each change affecting basic salary during the period of service. Any period of nondeduction service claimed on the front of this form
which cannot be verified from official records should be listed and noted in the "Leave Without Pay" column as "Unverified." NOTE: This information
will also be requested (on the SF 2801-1) in connection with the employee's retirement. The agency should keep a copy of this schedule to facilitate
completion of the SF 2801-1.
Nature of action Effective date
Basic
Salary basis
Leave
If basic salary actually earned is available,
make summary entry below.
(Appt., pro., res., etc.) (mm/dd/yyyy)
salary rate
(per annum, per
hour, WAE, etc.)*
without pay
From
(mm/dd/yyyy)
To
(mm/dd/yyyy)
Total
Earned
*If part-time, provide the number of hours in the scheduled tour of duty and dates of each change in tour of duty. If employee claims to have worked more
than the scheduled tour(s), provide number of hours worked at each pay rate. If intermittent (WAE), provide the number of hours or days worked, if
available, at each pay rate.
Certification -The information entered above is based on official records of this agency and is correct. There is no official personnel or fiscal record
in this agency of the additional service (if any) alleged by the employee and marked "Unverified" in item 3.
Agency address
Signature Date (mm/dd/yyyy)
Official title
Email address
Telephone number (including area code)
( )
Fax number (including area
code)
( )
Privacy Act and Public Burden Statement
Solicitation of this information is authorized by the Civil Service Retirement law (Chapter 83, title 5, U.S. Code). 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. The information may be shared and is subject to verification, via paper, electronic media, or through
the use of computer matching programs, with national, state, local or other charitable or social security administrative agencies in order to determine benefits under their
programs, to obtain information necessary for determination or continuation of benefits under this program, or to report income for tax purposes. It may also be shared and
verified, as noted above, with law enforcement agencies when they are investigating a violation or potential violation of civil or criminal law. Executive Order 9397 (November
22, 1943) authorizes the use of the Social Security Number. Failure to furnish the requested information may delay or make it impossible for us to determine your eligibility to
make payments.
We estimate this form takes an average 30 minutes per response to complete, including the time for reviewing instructions, getting the needed data, and reviewing the
completed form. Send comments regarding our estimate or any other aspect of this form, including suggestions for reducing completion time, to the Office of Personnel
Management (OPM), Retirement Services Publications Team (3206-0134), Washington, DC 20415-3430. The OMB Number 3206-0134 is currently valid. OPM may not
collect this information, and you are not required to respond, unless this number is displayed.
Standard Form 2803
Revised June 2013
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Information Regarding Deposit and Redeposit
Civil Service Retirement System
Detach this information sheet before filling out the application.
Read this information carefully before filling out the attached application.
Who Should Use This Application?
You should use this application if you are covered by the Civil Service Retirement System (CSRS) and you want to pay a deposit or a
redeposit for civilian service. You should not use this application if you are covered by the Federal Employees Retirement System (FERS).
Credit for Military Service Performed After December 31, 1956
To make payment for military service performed after December 31, 1956, refer to the instructions on SF 2803A, Application to Pay Military
Deposit, which is part of this package. Only current CSRS-covered employees may apply to pay military deposits.
What You Should Know About Deposit for Civilian Service Under CSRS
Deposit is a payment to the retirement fund to cover a period of
civilian service during which no retirement deductions were
withheld from your salary (also called "nondeduction" service).
You do not have to make a deposit if you do not wish to do so.
However, if you do not make the deposit
For nondeduction service performed before October 1,
1982, you will receive credit toward your retirement annuity.
Your annuity will be permanently reduced by 10% of the
amount due as a deposit. For example, if a deposit of $600 is
required and it is not paid, the annuity is permanently reduced
by $60 a year (or $5 a month). On the other hand, if a deposit
of $600 is made, it will increase the annuity by $60 a year.
For nondeduction service performed on or after October
1, 1982, you will receive no credit in the computation of your
annuity. The period of service will be creditable for title and
average salary purposes whether or not a deposit is made.
The amount of your deposit will be the percentage of your basic
salary shown below, plus interest.
Deduction
Dates of Service
Rate
July 1, 1926, and June 30, 1942 ........................................... 3.50%
July 1, 1942, and June 30, 1948................................................. 5%
July 1, 1948, and October 31, 1956 ........................................... 6%
November 1, 1956, and December 31, 1969 ........................ 6.50%
January 1, 1970, and December 31, 1998 .................................. 7%
January 1, 1999, and December 31, 1999 ............................. 7.25%
January 1, 2000, and December 31, 2000 ............................. 7.40%
After December 31, 2000 ........................................................... 7%
(Certain special categories of employees are subject to higher
percentage deductions as specified in 5 U.S.C. 8334.)
What You Should Know About CSRS Redeposit
Redeposit is a payment to the retirement fund to cover a period of
service for which retirement reductions were withheld from your
salary and later refunded to you.
You do not have to make a redeposit if you do not wish to do so.
However, if you do not make the redeposit
For service which ended on or after March 1, 1991,
you will receive no credit in the computation of your annuity
for the period of service covered by the refund. This usually
results in a reduction in the amount of your annuity, or, in the
event of death, your eligible widow's (or widower's) annuity.
The period of service will be creditable for title and average
salary purposes whether or not a redeposit is made.
For service which ended before March 1, 1991, if your
final separation occured on or after October 29, 2009, you
will receive credit in your annuity computation for the period
of service covered by the refund.
If you do not pay the redeposit for this service, your annuity
will be permanently, actuarially reduced because the redeposit
is not paid. The amount of the reduction will be based on
factors which will be divided into the amount of redeposit and
interest you owe at retirement.
If you retire on disability, you will not receive credit for
service with unpaid redeposits. This means that should you
retire because of a disability, you could find that you must pay
for the service to receive credit for it and that the accrual of
interest has increased the amount you must pay.
The amount of redeposit will be the sum of the refund plus
interest from the date the refund was paid to the date of redeposit
(or commencing date of annuity, whichever is earlier).
Standard Form 2803
Revised June 2013
How Interest Is Computed on Deposits
How Interest Is Computed on Redeposits
Interest is computed on the deposit from the midpoint of each
Interest is computed on the redeposit from the date the refund
period of nondeduction service.
was paid.
Interest for nondeduction service performed before October
1
, 1982, accrues daily and is charged at the following rates,
compounded annually:
4 percent through December 31, 1947; and
3 percent from 1948 through the date the deposit is made
or to the commencing date of annuity, whichever is
earlier.
Additional interest does not accrue if payment is made in full
within 30 days after the Office of Personnel Management
(OPM) issues the billing statement.
Interest for nondeduction service performed on or after
October 1, 1982, accrues annually, is compounded annually
on December 31 of each year, and is charged at the following
rates:
3 percent through December 31, 1984; and
At a variable rate determined annually by the
Department of Treasury beginning January 1, 1985. The
variable interest rate for any year equals the overall
average yield to the fund from retirement securities
during the preceding fiscal year.
No interest is charged for a year when payment in full is
received by December 31 of that year.
If the refund was based on an application received by the
employing agency or OPM before October 1, 1982, interest on
the redeposit accrues daily beginning on the date the refund
was paid and is charged at the following rates, compounded
annually:
4 percent through December 31, 1947; and
3 percent from 1948 through the date the redeposit is
made, or to the commencing date of annuity, whichever
is earlier.
Additional interest does not accrue if full payment is made
within 30 days after the billing statement is issued.
If the refund was based on an application received by the
employing agency or OPM after September 30, 1982, interest
is charged beginning on the date the refund was paid, at the
following rates, compounded annually:
3 percent through December 31, 1984; and
A variable rate determined by the Department of
Treasury beginning January 1, 1985. The variable rate for
any year equals the overall average yield to the fund from
retirement securities during the preceding fiscal year.
For post-September 30, 1982, refunds, interest is not charged
for a year when payment in full is received by December 31
of that year.
Procedures Governing Civil Service Retirement System (CSRS) Deposit And Redeposit
Deposits and redeposits can be made by employees now serving
under the CSRS, by separated employees who are entitled (or
would be entitled after paying for service) to an annuity, or by
eligible widows, widowers, or former spouses of deceased
employees. An applicant for retirement is automatically given an
opportunity to make the deposit for nondeduction service
performed on or after October 1, 1982, and any redeposit when
the application for retirement is processed. An applicant for
retirement must specifically request an opportunity to make a
deposit for nondeduction service performed before October 1,
1982. An employee should not file an application to make
deposit or redeposit if he or she contemplates retirement
within six months.
If you are employed by the Federal or District of Columbia
Government, you must send your completed application to your
department or agency first because they must certify it.
If you are separated from the Federal or District of Columbia
Government, send your completed application directly to the
Office of Personnel Management, Retirement Operations Center,
Deposit Section, P.O. Box 45, Boyers, PA 16017-0045.
Instructions for making payment together with a statement for the
amount due will be sent to you as soon as the processing of your
application is completed.
Installment payments of at least $50 are acceptable. However,
interest accrues on the unpaid balance. You may authorize
direct debit payments. You will receive information about
how to authorize direct debit payments when you receive your
statement.
Specify the service you want to pay for. Contact your
retirement counselor to discuss the advantages of paying for
one period of service over another before you make your
decision. After you have paid in full for the period of service
you select, please notify us if you want us to bill you for any
other service.
You cannot withdraw the payments you make unless you
become eligible for and obtain a refund of all your retirement
deductions.
Additional information and assistance in completing this
application may be obtained from the personnel office of
the Government department or agency in which you are
employed. If this source of information is not available to you,
contact the Office of Personnel Management, Civil Service
Retirement System, Boyers, PA 16017-0045, or call us at
1-888-767-6738 (TTY: 1-855-887-4957) Monday through
Friday from 7:30 AM to 7:45 PM Eastern Time.
Standard Form 2803
Revised June 2013
Application To Pay Military Deposit
For Military Service Performed After December 31, 1956
You must be currently employed and covered under CSRS to make the military deposit.
You must complete the deposit in full before the separation on which your retirement benefit will be based.
Agency Use Only (To Be Completed By Agency HR Office)
Employee's Name Date of Birth (mm/dd/yyyy) Social Security Number
To Be Completed By Employee
1. Information About Employee's Military Service
2. Employee's Acknowledgment of Understanding of Military Service Credit and Deposit Rules
Branch of Military Period of Service
Beginning Date
(mm/dd/yyyy)
Ending Date
(mm/dd/yyyy)
Does Alternative Deposit Calculation
Under USERRA Apply?
(Check appropriate box)
Interest Accrual Date (IAD)
(mm/dd/yyyy)
Yes No
Certification: The information entered above is based on official records of this
agency and is correct.
Agency Official Signature
Date (mm/dd/yyyy)
I am currently employed in a position where deductions for the Civil Service Retirement System (CSRS) are being deducted from my salary, and I wish to
pay the deposit necessary to obtain credit for my military service after 1956. I understand that I must pay the entire deposit to my employing agency before
separation for retirement. I further understand that the military deposit cannot be deemed paid at retirement if I am eligible for and elect an alternative
annuity. If I do elect the alternative annuity upon retirement, any completed military deposits made to the Fund will be refunded to me along with any other
retirement contributions or payments I made to the Fund. Once I complete the deposit in full, I understand that it can only be refunded to me if I become
eligible for a refund of my retirement contributions or retire without waiving my military retired pay (if any).
I understand that for any given full period of military service that I have performed, if I do not complete the deposit for that full period of military service,
any payments I made that were applied to that full period of military service will be refunded to me when I retire or when I become eligible for a refund of
my retirement contributions. I also understand each of the following service credit rules and how they apply to any given full period of military service that
I have performed for which I have not completed the military deposit:
For each period of military service performed after 1956:
If the first time I worked in a position where CSRS deductions were withheld from my salary was on or after October 1, 1982, the post-1956
military service will not be used to compute or establish title to CSRS annuity if I do not complete the deposit before I separate for retirement.
If the first time I worked in a position where CSRS deductions were withheld from my salary was before October 1, 1982, the post-1956
military service will not be used to compute my annuity at age 62 (or when I retire, if I retire after age 62), if I am eligible for Social Security
benefits at that time.
Finally, I understand that payment of this deposit will not make my military service creditable if it is otherwise not creditable under CSRS.
I realize that the Office of Personnel Management (OPM) is solely responsible for adjudicating and administering civil service retirement benefits.
I understand that OPM will determine if my military service can be credited in my CSRS retirement when I apply for my retirement benefits.
Telephone number where you can be reached during the Date (mm/dd/yyyy)
Employee's Signature Email address
day
( )
Standard Form 2803A
June 2013
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Information For Employee
Employee Instructions for Applying to Pay Post-1956 Military Service Deposit
Complete sections 1-16 on the front of the SF 2803, Application to Make Deposit or Redeposit.
Complete this form, SF 2803A, Application to Pay Military Deposit for Military Service Performed After December 31,1956.
Include a copy of your DD 214, Report of Transfer or Discharge, or equivalent record to verify your military service. If copies of the DD 214 are not
available, you should complete form SF 180, Request Pertaining to Military Records, and send it to the appropriate address (found on the form) to
verify your military service. You can obtain this form from your employing agency.
Attach documentation of military basic pay to this application. (See below)
Give the completed SF 2803, SF 2803A, and documentation noted above to your employing agency. Your agency will compute the military
deposit you owe and give you instructions for paying the deposit.
Employee Instructions for Completing this Form (SF 2803A)
Complete item 1 (Information About Employee's Military Service) by providing the branch of the military in which you served (e.g. Army, Navy,
etc.) and the dates of your military service. If you have more than one period of military service, make a separate entry for each period of military
service you performed. Note, a period of military service includes consecutive periods of service where there is no break in service. For military
purposes, a 1-day break separates service into two periods. Your agency will complete the section relating to the alternative deposit computation
rules and the interest accrual date.
Read the information in item 2 and then sign and date the form, and provide a telephone number and email address where you can be reached
during the day, at the bottom of item 2.
To Obtain Documentation of Military Basic Pay
Basic pay earnings may be documented by either of the following methods:
Actual pay records from the military service. Your agency can tell you what military pay records are acceptable for documenting actual military
earnings.
Estimated earnings, if you do not have official records of military earnings for the entire period of service. To obtain these estimated earnings from
the military, use RI 20-97, Request for Estimated Earnings During Military Service. You can obtain this form from your employing agency. You
must attach a copy of your DD 214 for the period of military service and any available records of pay and promotions. If the alternative deposit
calculation under USERRA applies to a period of military service, you should check with your agency for special instructions for requesting
estimated earnings if you received civilian pay (military leave, annual leave) during your period of military service.
The following records may not be used to document earnings:
Earnings statements from tax records. (They include allowances as well as basic pay.)
Social Security earnings statements. (They include allowances as well as basic pay and also reflect only military basic pay earned up to the Social
Security maximum wage base for withholding.)
Information For Employing Agency
Agency Instructions: The employing agency (or organization designated by the agency to administer the personnel records of the employee) must
complete the Agency Use Only section for every application before the action is processed through payroll. The agency must indicate if the period is
subject to the special comparative deposit calculation rules specified in the Uniformed Services Employment and Reemployment Rights Act (USERRA)
of 1994, as amended, by checking the appropriate block (Yes or No) under the Does Alternative Deposit Calculation Under USERRA Apply? column.
Do not leave that column blank. And, for each period of military service listed, the agency must provide the interest accrual date for the military deposit.
Finally, an authorized agency official should sign and date the certification section.
Reverse of Standard Form 2803A
June 2013
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