Annuity Supplement Earnings Report
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Annuity Supplement Earnings Report Form. This is a Official Federal Forms form and can be use in Retirement And Insurance US Office Of Personnel Management.
Tags: Annuity Supplement Earnings Report, RI 92-22, Official Federal Forms US Office Of Personnel Management, Retirement And Insurance
2003 Annuity Supplement Earnings Report
RI 92-22 Revised November 2003
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OMB No. 3206-0194
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United States Office of Personnel Management
Retirement Surveys and Students Branch
1900 E St., NW
Washington, DC 20415-3562
For Agency Use Only
Date Case Name
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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.
Complete and return this form ONLY if your allowable earnings were MORE THAN $11,520.00.
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.
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We apply the test only to earnings you received in 2003 after retirement and after you turn the Minimum
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