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Name
*
First
Last
Email (Please do NOT use a .gov email address)
*
Due to email deliverability issues, we request you not use your .gov email address to complete this form.
Phone
*
Current Age:
*
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Calculating Extra Basic Benefit Logic (Not Seen by Consumer)
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Number for Calculating Extra Basic Benefit (35 and younger))
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Number for Calculating Extra Basic Benefit (36)
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Number for Calculating Extra Basic Benefit (37)
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Number for Calculating Extra Basic Benefit (38)
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Number for Calculating Extra Basic Benefit (39)
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Number for Calculating Extra Basic Benefit (40)
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Number for Calculating Extra Basic Benefit (41)
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Number for Calculating Extra Basic Benefit (42)
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Number for Calculating Extra Basic Benefit (43)
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Number for Calculating Extra Basic Benefit (44)
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Number for Calculating Extra Basic Benefit (45 or higher)
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Date of Birth
*
Month
Day
Year
1) Benefit Statement Retirement SCD (Service Computation Date)
*
Month
Day
Year
2) Benefit Statement Leave SCD (Service Computation Date)
*
Found on your annual benefit statement from MyEPP.
Month
Day
Year
3) FERS Retirement Code Selector
*
Were you hired...
Please Select One
Before January 1, 2013
During 2013
After December 31, 2013
Choose your occupation: (Hired during 2013)
Regular Employee
USPS Regular Employee
USPS Law Enforcement
Law Enforcement Officer / Agent / OIG
Firefighter
Air Traffic Controller
Choose your occupation: (Before January 1, 2013)
Regular Employee
USPS Regular Employee
USPS Law Enforcement
Law Enforcement Officer / Agent / OIG
Firefighter
Air Traffic Controller
Choose your occupation: (After December 31, 2013)
Regular Employee
USPS Regular Employee
USPS Law Enforcement
Law Enforcement Officer / Agent / OIG
Firefighter
Air Traffic Controller
Hidden
FERS Retirement Code Selection ( Not seen by the consumer )
Hidden
K
Hidden
K Label
Hidden
No Code - Before - USPS Law
Hidden
No Code - Before - USPS Law Label
Hidden
M - law
Law Enforcement, etc.
Hidden
M Label - law
Law Enforcement, etc.
Hidden
M - fire
Fire Fighters
Hidden
M Label - fire
Fire Fighters
Hidden
L
Hidden
L Label
Hidden
Hidden
KR
Hidden
KR Label
Hidden
No Code - During - USPS Law
Hidden
No Code - Before - USPS Law Label
Hidden
MR - law
Law Enforcement
Hidden
MR Label - law
Law Enforcement
Hidden
MR - fire
Fire Fighter
Hidden
MR Label - fire
Fire Fighter
Hidden
LR
Hidden
LR Label
Hidden
Hidden
KF
Hidden
KF Label
Hidden
No Code - After - USPS Law
Hidden
No Code - After - USPS Law Label
Hidden
MF - law
Law Enforcement
Hidden
MF Label - law
Law Enforcement
Hidden
MF - fire
Firefighter
Hidden
MF Label - fire
Firefighter
Hidden
LF
Hidden
LF Label
Hidden
4) Social Security Retirement Benefit at Age 62
*
Or a later age if you're already 62 or older.
5) Social Security Disability Benefit
*
Look for it on page 1 of your SSA statement; if not eligible yet, enter $0
6) Current TSP Balance:
Pay Statement
Input Items from Your E&L (Pay) Statement.
7) Your Annual Salary:
*
Special Instructions:
From this point downward, please input your pay period deductions from the P/P column of your pay statement
8) Deduction 75 02 - Retirement
*
9) Agency Retirement Contribution This Pay Period.
*
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.
10) Add Deduction 75 15 TSP-FERS to 75 24 Catch Up and input your total:
*
11) Deduction 76 Social Security (OASDI)
*
12) Add Deduction 77 FEDERAL TAX to EXTRA TAX (If Applicable) and input your total.
*
If the value is $0 please input "0"
13) Deduction 78 STATE TAX
*
If the value is $0 please input "0"
14) Deduction 81 - Are You Enrolled In FEGLI Basic?
*
Please Select One
Yes
No
15) Employee FEGLI Basic Cost This Pay Period:
*
Since You Are Enrolled In FEGLI Basic, Are You Also Enrolled In Any Of The Following?
Choose all that apply.
Option A
Option B
Option C
Hidden
Default Value if B is not selected
Hidden
Default Value if C is not selected
Select Your Option B Number of Multiples
*
1
2
3
4
5
Select Your Option C Number of Multiples
*
1
2
3
4
5
16) Deduction 83 FEHBA
*
17) Deduction 97 MEDICARE TAX WITHHELD
*
18) Annual Leave Balance (In Hours):
19) Sick Leave Balance (In Hours):
20) Do You Know Your High 3 Salary Average?
*
If you will retire within 3 years, choose "yes" and provide it. Otherwise, choose "no" and provide your current salary again.
Please Select One
Yes
No
Please enter your Gross Annual Pay Once Again
*
What Is Your High 3 Salary Average?
*
Review
Please make sure all your information looks correct before submitting.
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