Fillable 19-107a1 Notification to OPM of Reemployment of Annuitant

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19-107a1 Notification to OPM of Reemployment of Annuitant

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NOTIFICATION TO OPM OF REEMPLOYMENT OF ANNUITANT
OPM requires the below information to determine continued eligibility for annuity. The agency must
complete and send this form, along with a copy of the SF 50 to our email address at:
ReemployedAnnuitant@opm.gov
1. Retirement Claim Number:
2. Name of Annuitant:
3. Date of Birth: 4. SSN:
Appointment
5. Type
of Appointment:
6. Date of Appointment (Month, Day, Year):
7. Presidential Appointment? ______Yes ________No
8.
Dual Comp Waiver (including FEPCA and Public Laws 103-336,10
8-136, 108-447 and 108-458) in
effect? ________Yes _______No
If “No”, indicate Retirement System: CSRS/CSRS Offset_________________
FERS________________FICA__________________
9. Was this appointment granted to provide interim relief pending further judicial or administrative review
of an agency adverse action, under the provisions of 5CFR 772.102?
____Yes ____No
Insurance
10. Does appointment allow FEGLI coverage? ________Yes ________No
11. If so, did annuitant make new elections? No (if no, go to Item 11) Yes_
_________
_______ ( if yes,
please en
close copy of new elections)
12. If a
nnuitant did not complete a new election, agency should pick-up all FEGLI carried into retirement
as of reemployment date except for Option B. What deductions for life insurance does annuitant have
under reemployment?
None________ Basic__________Option A_____________Option C___________
Option B__________ (note: annuitant can elect to keep Option B under employment, otherwise it is
withheld from annuity)
Did annuitant elect Option B withhold from employing agency? _______Yes ________No
If “Yes”, Effective date:_________________________
13. Did annuitant elect to waive Premium Conversion? If yes, Effective date:
_________________________
If subject is a disability annuitant, complete the items 14-17:
14. Position Description:
15. Pay System/Grade:
16. Salary ________________
17. Tour of Duty (if applicable)_________________
Department of Defense Agencies Only
Public Law 108-136 implemented a blanket dual compensation waiver for annuitants reemployed at a DoD agency.
This means that the reemployment provisions in title 5 do not apply to these annuitants. They will not be subject to
salary offset (or to an administrative recovery finding if a disability retirement). Nor will they be eligible for an
additional benefit based on the reemployment service. This waiver applies to all types of retirement except for an
Involuntary Retirement. A subsequent law (P.L. 110-181) provided an opportunity for annuitants retired under an
involuntary retirement who reemploy with DoD to elect to waive the provisions of the dual compensation legislation
and be subject to coverage as a reemployed annuitant. The legislation provides that an election for coverage must be
filed not later than the latter of 90 days after the date the Department of Defense: (i) prescribes regulations to carry
out this subsection; or (ii) takes reasonable actions to notify employees who may file an election. If an employee
files an election under this paragraph, coverage will be effective beginning on the first day of the first applicable pay
period beginning on or after the date of the filing of the election. If an annuitant whose retirement was involuntary
waives the dual compensation waiver and opts to become a reemployed annuitant under title 5, agencies MUST
provide OPM with a copy of the annuitant waiver of the dual compensation waiver.
Agency Certification: I certify that the information provided above is correct.
_________________________ __________________________ ________________
Agency Representative Name Signature Date
_________________________ _________________________ ________________
Position Title Contact Number FAX Number
_______
____
______________
Email Address
Agency Name and Address:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________ _________________________________ ________
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19-107a1 Notification to OPM of Reemployment of Annuitant

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Completed 26 February 2020

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