Notice of Correction of Individual
Standard Form 2806-1
Rev. February 1980
Retirement Record
Office of Personnel Management
Previous edition is usable.
Civil Service Retirement System
Office of Personnel Management
Retirement Operations Center
P.O. Box 45
Boyers, PA 16017-0045
Please correct the Standard Form 2806 for the former employee named below as indicated:
Name of employee Date of birth (mm/dd/yyyy) Social Security Number
Agency Payroll office number Location (including ZIP Code)
Reason for correction
Fiscal Data
Total Cumulative
Deductions
Current Year
Data shown on Standard Form 2806
Corrected Data
Amount of overstatement of total deductions
Service History Data
(Name, date of birth, appointment, separation, promotion, etc. - specify which)
Data shown on Standard Form 2806 Corrected Data
Standard Form 2806 forwarded to OPM on
Register Dated
Certification
I certify that the corrections shown above are correct.
Signature DateTitle
