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Name*
Due to email deliverability issues, we request you not use your .gov email address to complete this form.
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Calculating Extra Basic Benefit Logic (Not Seen by Consumer)

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Date of Birth*
1) Benefit Statement Retirement SCD (Service Computation Date)*


2) Benefit Statement Leave SCD (Service Computation Date)*
Found on your annual benefit statement from MyEPP.



Were you hired...

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FERS Retirement Code Selection ( Not seen by the consumer )

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Law Enforcement, etc.
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Law Enforcement, etc.
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Fire Fighters
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Fire Fighters
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Law Enforcement
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Law Enforcement
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Fire Fighter
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Fire Fighter
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Law Enforcement
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Law Enforcement
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Firefighter
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Firefighter
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Or a later age if you're already 62 or older.



Look for it on page 1 of your SSA statement; if not eligible yet, enter $0



Pay Statement

Input Items from Your E&L (Pay) Statement.


Special Instructions:

From this point downward, please input your pay period deductions from the P/P column of your pay statement


If you don't have it, it is on MyEPP, the 2nd page of your pay statement, which does not normally print with the 1st page. Go back to MyEpp > E&L Statements>scroll past the 1st page.



If the value is $0 please input "0"


If the value is $0 please input "0"



Since You Are Enrolled In FEGLI Basic, Are You Also Enrolled In Any Of The Following?
Choose all that apply.
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If you will retire within 3 years, choose "yes" and provide it. Otherwise, choose "no" and provide your current salary again.

Review

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