Certification for Physicians Comparability Allowances (PCA)
RI 20-122
July 2003
Physicians Comparability Allowance received on or after December 28, 2000, is considered basic pay for:
• Computing disability retirement benefits, and
• Computing survivor benefits for death-in-service
For all other retirement computations, employees must have at least 15 years of service as a Government physician before
PCA received on or after December 28, 2000, can be considered as basic pay for the average salary computation. The
amount of PCA included in basic pay is based on the total amount of service performed as a Government physician on or after
December 28, 2000.
1. Name of employee 2. Date of Birth 3. Social Security Number
4. Type of Retirement Action
Death (100% of PCA received after 12/27/00 included as basic pay)
Disability (100% of PCA received after 12/27/00 included as basic pay)
Other Retirement: Voluntary, Early, DSR, Deferred, etc.
5. Has retiree met the 15 year service requirement as a physician?
N/A (Death-in-Service or Disability Retirement)
No (not eligible for PCA in base pay)
Yes (See item 6)
6. PCA payment attributable to service performed on or after December 28, 2000, will be included as basic pay for retirement purposes, based on the total
amount of service performed as a Government physician on or after December 28, 2000, as indicated below. (Check appropriate box below)
Less than 2 years service (0% of PCA included as basic pay)
At least 2 but less than 4 years service (25% of PCA included as basic pay)
At least 4 but less than 6 years service (50% of PCA included as basic pay)
At least 6 but less than 8 years service (75% of PCA included as basic pay)
At least 8 years service (100% of PCA included as basic pay)
7. Summary of Pay Adjustments with Physicians Comparability Allowance on or after December 28, 2000
A B
C
D E
F
Effective Date
of Pay Change
PCA
Amount
x
%
=
Creditable
PCA
+
Basic
Pay Rate
=
Average Salary
Pay Rate
x
= + =
x
= + =
x
= + =
x
= + =
x
= + =
x
= + =
x
= + =
x
= + =
x
= + =
8. Agency Certification: I certify that the information on this form accurately reflects information contained in the Official Personnel Folder and/or Payroll
records in the custody of this agency.
Print or type name Agency name and address
Signature Date
Title and telephone number (including area code)
This form may be locally reproduced
