2003 Annuity Supplement Earnings Report RI 92-22 Revised November 2003 Show any address change next to your address below Form Approved OMB No. 3206-0194 15046 15046 $118,7< 6833/(0(17 ($51,1*6 5(3257 6KRZ DQ\ DGGUHVV FKDQJH QH[W WR \RXU DGGUHVV EHORZ United States Office of Personnel Management Retirement Surveys and Students Branch 1900 E St., NW Washington, DC 20415-3562 &ODLP 1XPEHU Claim Number For Agency Use Only Date Case Name )RU $JHQF\ 8VH 2QO\ The annuity supplement part of your FERS benefit is subject to an earnings test similar to the one applied to social security benefits and uses the same exempt amount, as required by law in 5 U.S.C. 'DWH III II I Complete and return this form ONLY if your allowable earnings were MORE THAN $11,520.00. IV &DVH 1DPH Section 8421a. Your annuity supplement will be reduced $1.00 for every $2.00 by which you exceed the exempt amount ($11,520.00 for 2003). By law, this reduction is effective July 1, 2004. &RPSOHWH DQG UHWXUQ WKLV IRUP 21/< LI \RXU DOORZDEOH HDUQLQJV ZHUH 025( 7+$1 We apply the test only to earnings you received in 2003 after retirement and after you turn the Minimum 7 K H DQ Q X LW\ VX SSOHP HQ W SDUW RI \ RX U ) (5 6 EHQ HILW LV VX EMHFW WR DQ HDUQ LQ JV WHVW VLP LODU WR WK H RQ H D SSOLHG WR VRFLDO VHFX ULW\ EHQ HILWV DQ G X VHV WK H VDP H H[ HP SW DP RX Q W DV UHTX LUHG E\ ODZ LQ 8 6 & 6HFWLRQ D