Fillable 19-107a2 Notification to OPM of Seperation of a Reemployed Annuitant - N Benefits Payable

Fill Online, Printable, Fillable, Blank 19-107a2 Notification to OPM of Seperation of a Reemployed Annuitant - N Benefits Payable Form

Use Fill to complete blank online U.S. OFFICE OF PERSONNEL MANAGEMENT (GA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

19-107a2 Notification to OPM of Seperation of a Reemployed Annuitant - N Benefits Payable

On average this form takes 5 minutes to complete

The 19-107a2 Notification to OPM of Seperation of a Reemployed Annuitant - N Benefits Payable form is 1 page long and contains:

  • 1 signature
  • 3 check-boxes
  • 14 other fields

Country of origin: US
File type: PDF

U.S.A. forms for U.S. Office of Personnel Management

BROWSE U.S. OFFICE OF PERSONNEL MANAGEMENT (GA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
NOTIFICATION TO OPM OF SEPARATION OF A REEMPLOYED ANNUITANT- NO BENEFITS PAYABLE
NAME: D
OB: SSN:
Claim Nu
mber:
DATE OF SEPARATION ______________________________________
Does this annuitant have a disability retirement? ______Yes ______No
REEMPLOYED ANNUITANT WAS UNDER A DUAL COMPENSATION WAIVER. PLEASE RESTORE
FEHB _______ FEGLI_________
REEMPLOYED ANNUITANT SEPARATED PRIOR TO ATTAINING ONE FULL YEAR OF SERVICE.
PLEASE RESTORE
FEHB ________ FEGLI ____________
APPLICATION FOR REFUND OF EMPLOYEE DEDUCTIONS WILL BE SUBMITTED
SEPARATION SF 50 IS ATTACHED
AGENCY EMAIL ADDRESS___________________________ AGENCY PHONE #_______________
_
AGENCY OFFICIAL SIGNATURE ___________
________________ DATE ________________________
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

19-107a2 Notification to OPM of Seperation of a Reemployed Annuitant - N Benefits Payable

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 26 February 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document