Fillable Sf3107pr Agency Checklist for Phased Retirement - FERS

Fill Online, Printable, Fillable, Blank Sf3107pr Agency Checklist for Phased Retirement - FERS 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.

Sf3107pr Agency Checklist for Phased Retirement - FERS

On average this form takes 15 minutes to complete

The Sf3107pr Agency Checklist for Phased Retirement - FERS form is 2 pages long and contains:

  • 2 signatures
  • 82 check-boxes
  • 13 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
 
SF 3107 PR
Revised April 2019
Previous edition is not usable.
Agency Checklist for Phased Retirement - FERS
Section A - Employing Office Checklist
To be completed by office maintaining Official Personnel Folder
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
1. SF 3107: Application for Immediate Retirement - the following sections are completed:
Section A: Identifying
I
nformation
Section B: Federal Serv
ice
(Item 2, Date of final separation, should not be completed.)
Section C: Marital Information
Item 1 through 1f is optional
Item 2, if there is a Court Order for apportionment of federal annuity
Section D: Annuity Election
Section E: Insurance Information
Section F:
Other Claim Information
Section G: In
formation about Children
Section H: Direct Deposit and Tax Withholding Information
Section I: Applicant's Certification
Schedule A: Military Service Information
Schedule B: Military Retired Pay
Schedule C: Federal Employees' Compensation Information
2. SF 3107-1: Certified Summary of Federal
Service
3. If applicant wants to waive military retired p
ay, 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 3107
5. If applicant has military service document (DD214 or its equivalent)
6. If applicant wants a refund of a military service deposit because he/she does not want
to
waive military retired pay, submitting SF 3106?
7. If post 1956 military service involved and deposit not made, was applicant counseled about
the ef
fects of not paying the deposit? Attach OPM Form 1515, if available.
8. Employee Election of Ph
ased 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
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
12. Official Title
12a. Person to contact for further information
13. Telephone number, FAX number, and E-mail address
14. Address
15. Submitting Office Number (SON)
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.
click to sign
signature
click to edit
Reverse of SF 3107 PR
Revised April 2019
Payroll Provider Checklist for Phased Retirement - FERS
Section B - Payroll Office Checklist
To be completed by the office maintaining the Individual Retirement Record (SF 3100/3100A)
The Individual Retirement Record (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: The SF 3100/3100A 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. Do
es the SF 3100/3100A for the applicant named in Section A contain all information
necessary to comply
with OPM instructions for maintaining the IRR?
2. Is the applicant someone who elected to transfer to FERS
and who is entitled to have a
portion of his or her benefits computed under CSRS?
3. Has applicant made a military service deposit with your office?
4.
If “yes”, is th
e SF 3100/3100A f
or t
he deposit attached?
5. Does the applicant hav
e any part time service on or after April 7, 1986?
6. If “yes”, is the number of hours in each scheduled tour of duty of each change in tour of
duty post
ed on the SF 3100/3100A?
7. If applicant is a Postal Service employee, are postal earnings for non-ded
uction service
show
n on SF 3100/3100A?
8. Disposition of
SF 3100/3100A: SF 3100 or SF 3100A and Register of Separatio
ns and
Transfers (SF 3103) are attached
8a. If SF 3100/3100A was already forwarded, provide the following: Forwar
ded To, SF 3103 Number, and Date (mm/dd/yyyy)
of SF 3103
Payroll Certification
I certify that the above reflects official records maintained by this office.
Signature of Chief Payroll Officer or Designee Payroll Office Number
Telephone number, FAX number, and E-mail address Date (mm/dd/yyyy)
PRINT
SAVE
CLEAR
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

Sf3107pr Agency Checklist for Phased Retirement - FERS

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 9 December 2019

Message

View Audit Log
Print With Audit Log
Duplicate Document