Fillable Sf2801pr Agency Checklist for Phased Retirement - CSRS

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Sf2801pr Agency Checklist for Phased Retirement - CSRS

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  • 77 check-boxes
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SF 2801 PR
Revised April 2019
Previous edition is not usable.
Agency Checklist for Phased Retirement - CSRS
Name of applicant (last, first, middle): Date of birth: Social security number:
Are the following documents attached or actions taken?
Indicate by a "check mark" for each item
Yes No
Not
Applicable
Section A: Identifying Information
Section B: Federal Service
(Item 2, Date of final separation, should not be completed.)
Section C: Other Claim Information
Section D: Insurance Information
Section E: Ma
rital Information
Item 1 through 1f is optional
Item 2, if there is a Court Order for apportionment of federal annuity
Section F: Annuity Election
Section G: Information about Your Unmarried
Dependent Children
Sectio
n H: Direct Deposit and Tax Withholding Information
Section I: Appli
cant's Certification
Schedule A: Military Service Information
Schedule B: Military Retired Pay
Schedule C: Federal Employees' Compensation Information
2. SF 2801-1: Certified Summary of Federal Service
3. If applicant
wants to waive military retired pay, copy of waiver request and response from
Military Retired Pay Center, if available
4. If applicant served in the military, or applied for military retired pay or DOVA benefits in
lieu of military retired pay, or applied for OWCP benefits, Schedules A, B, C of SF 2801
5. If applicant has military service document (DD214 or its equivalen
t)
6. If applicant wants a
refund of a military service deposit because he/she does not want
to waive military retired pay, submitting SF 2802?
7. If post 1956 military service involved and deposit not made, was applicant counseled about
the effects of not paying the deposit? Attach OPM Form 1515, if available.
8. Employee Election of Phased Annuity (SF 3116, Part 1A) included in package (
mandatory)
9. If applicant wants Federal Income tax withheld at the same rate as an employee,
copy of W
-4 form
1. SF 2801: Application for Immediate Retirement
- the following sections are completed:
Section A - Employing Office Checklist
To be completed by office maintaining Official Personnel Folder
10. Agency estimate of annuity
Agency Certification
I certify that the above accurately reflects verified information in official records and that the applicant has sufficient service to be
entitled to an annuity.
11. Signature of Chief Human Resources Officer or Designee 14. Address
12. Official Title
12a. Person to contact for further information 15. Submitting Office Number (SON)
13. Telephone number, FAX number, and E-mail address 16. Date (mm/dd/yyyy)
Offenses Barring Annuity Payments: Public Law 87-299 prohibits payment of annuity to persons who have committed specified
offenses involving the national security of the United States. Employing agencies are responsible for submitting all pertinent information
to the Office of Personnel Management Retirement Services Program, in any case when this law possibly applies.
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Reverse of SF 2801 PR
Revised April 2019
Payroll Provider Checklist for Phased Retirement - CSRS
Section B - Payroll Office Checklist
To be completed by the office maintaining the Individual Retirement Record
The IRR must have the Military Deposit Status posting. (Note: FEHB, FEGLI, Unused Sick Leave, and Last Day in Pay postings are
NOT applicable in the phased retirement IRR).
Important: Th
e SF 2806 must be closed out and received by OPM within 30 days after the
employee's effective date of phased retirement.
Yes No
Not
Applicable
1.
Does the SF 2806 for the applicant named in Section A contain all information necessary to
comply with
OPM instructions for maintaining the Individual Retirement Record (IRR)?
2. Has applicant made a military service deposit with your office?
3. If “yes”, is the SF 2806 for the deposit attached?
4. Does the applicant have any part ti
me service on or after April 7, 1986?
5. If “yes”, is
the number of hours in each scheduled tour of duty of each change in tour of
duty posted on the SF 2806?
6. If applicant is a Postal Service employee, are postal earnings for
non-deduction service
shown on SF 2806?
7. Disposition of SF 2806: SF 2806 and Register of Separations and Transfers (SF 2807)
are attached
7a. If SF 2806 was already forwarded, provide t
he following: Forwarded To, SF 2807 Number, and Date (mm/dd/yyyy) of SF 2807
Payroll Certification
I certify that the above reflects official records maintained by this office.
Signature of Chief Payroll Officer or Designee
Telephone number, FAX number, and E-mail address
Payroll Office Number
Date (mm/dd/yyyy)
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Sf2801pr Agency Checklist for Phased Retirement - CSRS

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Completed 3 November 2019

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