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Federal HR Policies Affecting Schedule A Appointment

Appendix II - Forms

Forms Currently Used by CES (By Subject)

Most of the following forms come directly from the OPM, TSP, and DOL web sites.  Many of the these forms require the use of Adobe Acrobat Reader.

FORMS

TITLE

LINK

Retirement Pamphlets/Booklets/Handbook
RI-20-59 Information for Annuitants PDF
RI-25-26 Information for Survivor Annuitants PDF
RI-25-27 Survivor Benefits for Children   PDF
RI-30-13 Information for Disability Annuitants PDF
RI-83-1 Retirement Facts 1 - The Civil Service Retirement System   PDF
RI-83-2 Retirement Facts 2 - Military Service Credit Under the CSRS PDF
RI-83-3 Retirement Facts 3 - Deposits and Redeposits Under the CSRS PDF
RI-83-4 Retirement Facts 4 - Disability Retirement Under the CSRS PDF
RI-83-5 Retirement Facts 5 - Survivor Benefits Under the CSRS   PDF
RI-83-6 Retirement Facts 6 - Early Retirement Under the CSRS   PDF
RI-83-7 Retirement Facts 7 - Computing Retirement Benefits Under the CSRS PDF
RI-83-8 Retirement Facts 8 - Credit for Unused Sick Leave Under the CSRS PDF
RI-83-9 Retirement Facts 9 - Refunds Under the CSRS PDF
RI-83-10 Retirement Facts 10 - Voluntary Contributions Under the CSRS ) PDF
RI-83-11 Thinking About Retirement   PDF
RI-83-13 Retirement Facts 11 - Information for Separating CSRS Employees Who Are Not Eligible for an Immediate Annuity   PDF
RI-83-18 Retirement Facts 12 - Information About Re-employment in the CSRS  PDF
RI-83-19 Retirement Facts 13 - CSRS Offset Retirement PDF
RI-84-1 Court-Ordered Benefits for Former Spouses Under CSRS, FERS, FEHB, and FEGLI PDF
RI-84-2 Work-Related Injuries and Fatalities -- What You and Your Family Need to Know About Your Benefits PDF
RI-90-1 FERS Booklet (An Overview of Your Benefits)   WEB
RI-90-3 FERS Transfer Handbook -- A Guide to Making Your Decision PDF
RI-90-8 Information for People Who Have Retired Under FERS   PDF
RI-90-11 FERS FACTS 1 -- Information for Separating FERS Employees Who Are Not Eligible for an Immediate Annuity PDF
RI-90-12 Information for Survivor Annuitants WEB
RI-90-18 FERS FACTS 2 - Information About Re-employment for Federal Employees Retirement System Annuitants PDF
RI-98-2 Information for FERS Disability Annuitants WEB
Retirement Applications/Forms
OPM 1510 Certification of Agency Offer of Position and Required Documentation (For Discontinued Service Retirement under CSRS or FERS) (10/94) 
PDF
PDF/F
OPM 1515 Military Service Deposit Election (10/91)  PDF
SF-1152 Designation of Beneficiary - Unpaid Compensation of Deceased Civilian Employee (6/2002)  PDF/F
SF-2800 Application for Death Benefits (5/2000) PDF/F07/27/2007 SF-2801 Application for Immediate Retirement Under the CSRS (1/90)  PDF/F
SF-2802 Application for Refund of Retirement Deductions  - CSRS (4/99)  PDF/F
SF-2803 Application to Make Deposit or Redeposit - CSRS (2/2001)  PDF/F
SF-2804 Application to Make Voluntary Contribution - CSRS (7/99)  PDF/F
SF-2806 Individual Retirement Record - CSRS (2/80)  PDF
SF-2806-1 Notice of Correction of Individual Retirement Record (2/80) 
SF-2807 Register of Separations and Transfers - CSRS (7/80) 
PDF/F
SF-2808 Designation of Beneficiary - CSRS (2/99) 
PDF/F
SF-3100 Individual Retirement Record (1/87) 
SF-3101 Notification of Correction to Individual Retirement Record (1/87) 
(Must be printed on buff paper.)
SF-3102 Designation of Beneficiary - FERS (6/2000)  PDF/F
SF-3103 Register of Separations and Transfers - FERS (1/87) 
(Must be printed on goldenrod paper.)
SF-3104 Application for Death Benefits - FERS (8/2002) 
PDF/F
SF-3104B Documentation and Election in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death (5/2003) 
PDF/F
SF-3106 Application for Refund of Retirement Deductions - FERS (8/2000)  PDF/F
SF-3106A Current/Former Spouse's Notification of Application for Refund of Retirement Deductions Under the FERS (8/2000)  PDF/F
SF-3107 Application for Immediate Retirement - FERS (4/2000)  PDF/F
SF-3108 Application to Make Service Credit Payment for Civilian Service (11/2000)  PDF/F
SF-3109 Election of Coverage - FERS (7/99)  PDF/F
SF-3110 Former Spouses's Consent to FERS Election (6/90)  PDF/F
SF-3111 Request for Wavier, Extension, or Search in Connection with Election of FERS Coverage (6/90)  PDF/F
SF-3112 Documentation in Support of Disability Retirement Application (12/95)  PDF/F
SF-3112-1 Information About Disability Retirement (CSRS) (3/96) PDF
SF-3112-2 Information About Disability Retirement (FERS) (3/96) PDF
SF-3113 Applying for Immediate Retirement under the FERS (5/2001) PDF
SF-3114 Applying for Death Benefits under the FERS (8/2003) PDF
Thrift Savings Plan Program Forms/Booklets
TSP-1 TSP Election Form (1/2006) PDF
TSP-1-C Catch-Up Contribution Election (7/2005) PDF
TSP-3 TSP Designation of Beneficiary (6/2005)  PDF
TSP-9 Change of Address for Separated Participants (6/2005) PDF
TSP-16 Exception to Spousal Requirements (6/2005)  PDF
TSP-17 Information Relating to Deceased Participants (6/2005)  PDF
TSP-20 Loan Application (6/2005)  PDF
TSP-70 Withdrawal Request/Transfer Information (6/2005)  PDF
TSP-536 Important Tax Information About Payments from Your TSP Account (3/2005) PDF
TSP BK12 TSP In-Service Withdrawals (7/2004) PDF
TSP BK02 Withdrawing Your TSP Account After Leaving Federal Service (7/2004) PDF
TSP BK03 Guide to TSP Investments (8/2003) PDF
TSP BK04 TSP Loan Program (7/2004) PDF
TSP BK05 TSP Annuities (7/2004) PDF
TSP BK08 Summary of the TSP for Federal Employees Booklet (5/2001) PDF
TSP BK09 TSP at a Glance (6/2003) PDF
TSP BK11 TSP - Information About Court Orders (11/2004) PDF
Federal Employees Health Benefits Program Booklets/Forms
RI-70-1 2005 Guide to FEHB Plans (11/2004) PDF
RI-70-5 2005 Guide to FEHB Plans - for TCC and Former Spouse Enrollees (11/2004) PDF
RI-79-2 Information for Retirees and Survivor Annuitants About the Federal Employees' Health Benefits Program (5/2000)  PDF
RI-79-27 Temporary Continuation of Coverage (TCC) under the Federal Employees' Health Benefits Program (12/2000)  PDF
SF-2809 Health Benefits Registration Form (10/2004)  PDF/F
SF-2810 Notice of Change in Health Benefits Enrollment (6/95)  PDF/F
SF-2811 Transmittal and Summary Report to Carrier (6/84) 
SF-2812A Report of Withholdings and Contributions for Health Benefits by Enrollment Code) (8/88) 
SF-2812L Report of Withholdings and Contributions for Health Benefits, Life Insurance, and Retirement (1/90) 
Federal Employees' Group Life Insurance Program Forms/Booklets/Pamphlets
FE-6 Claim for Death Benefits - FEGLI (4/2004)  PDF/F
OPM 1482 Agency Certification of Status of Reemployed Annuitant - FEGLI Program (4/2000)  PDF/F
OPM 1523 Supplemental Semiannual Headcount Report (10/2003) 
PDF/F
RI-38-126 Life Events and Your Retirement and Insurance Benefits (for Annuitants) (7/98) PDF
RI-76-10 Assignment of Federal employees' Group Life Insurance (4/2000)  PDF/F
RI-76-12 Federal Employees' Group Life Insurance Program (5/2000) PDF
RI-76-21 FEGLI Program Booklet (10/2001) WEB
RI-84-3 Life Events and Your Retirement and Insurance Benefits (For Employees) (2/99) PDF
SF-2817 Life Insurance Election (6/2000)  PDF/F
SF-2818 Continuation of Life Insurance Coverage (5/2001)  PDF
SF-2819 Notice of Conversion Privilege (5/95)  PDF/F
SF-2821 Agency Certification of Insurance Status (5/95)  PDF/F
SF-2822 Request of Insurance - FEGLI (1/2002)  PDF/F
SF-2823 Designation of Beneficiary - FEGLI (4/2001)  PDF/F
Office of Workers' Compensation Program Forms/Booklets
CA-1 Federal Employees Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation (4/99)  PDF
CA-2 Notice of Occupational Disease and Claim for Compensation (1/97)  PDF
CA-2a Notice Recurrence (9/96)  PDF
CA-5 Claim for Compensation by Widow, Widower, and/or Children (1/97)  PDF
CA-5b Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren (1/97)  PDF
CA-6 Official Superior's Report of Employee's Death (1/97) PDF
CA-7 Claim for Compensation (11/99)  PDF
CA-7a Time Analysis Form (6/96)  PDF
CA-7b Leave Buy Back (LBB) Worksheet/Certification and Election (6/96)  PDF
CA-11 When Injured at Work WEB
CA-16 Authorizatin for Examination and/or Treatment (1/97) 
CA-17 Duty Status Report (1/97) 
PDF
CA-20 Attending Physician's Report (11/99)  PDF
CA-35 Evidence Required in Support of a Claim for Occupational Disease (8/88)  PDF
CA-550 Federal Injury Compensation, Handbook of Questions and Answers About the Federal Employees Compensation Act WEB
CA-810 Injury Compensation for Federal Employees, A Handbook for Employing Agency Personnel WEB
OWCP-915 Claimant Medical Reimbursement Form (8/2003) 
PDF
OWCP-1500 Health Insurance Claim Form (4/92) 

Back to CES HR Guidance Index

Last Updated: 07/09/2007