Application for Deferred or Postponed Retirement Federal Employees Retirement System Form Approved: OMB number 3206-0190 This application is for you if you are a former Federal employee who was covered by the Federal Employees Retirement System (FERS) and you wish to apply for your retirement annuity. You should complete this application if you choose to apply for an annuity which will begin more than 1 month after your separation from Federal service (or transfer to a position not covered by FERS) and: 1. 2. you have completed at least 5 years of creditable civilian service and are eligible for a deferred retirement at age 62; or you have completed at least 10 years of creditable service, including 5 years of civilian service, and are eligible for an annuity at the Minimum Retirement Age (MRA). Send your completed application (approximately 60 days before you want your benefits to begin) to: Office of Personnel Management Federal Employees Retirement System P.O. Box 45 Boyers, PA 16017-0045 You should have received the informational pamphlet RI 92-19A, Applying for Deferred or Postponed Retirement Under the Federal Employees Retirement System, with this application. If you did not receive this pamphlet, you can access the pamphlet on our website at www.opm.gov/Forms/. You can also get a copy by calling the Office of Personnel Management (OPM) at 1-888-767-6738 or by contacting us at the address above. If you use TTY equipment, call 1-855-887-4957. If your address changes before you receive your claim number, write to us giving your name, date of birth and social security number. If you have received your claim number, remember to refer to it. Instructions for Completing Application for Deferred or Postponed Retirement Type or print clearly. If you need more space in any section, use a plain piece of paper with your name, date of birth, and Social Security Number written at the top. If you do not know an answer write "unknown." If you are uncertain of any information you provide, answer to the best of your ability, followed by a question mark (?). The following information should help you to answer the questions on the application which are not self-explanatory. Section C - Military Service Item 1: Indicate whether you have performed active duty that terminated under honorable conditions in the armed services or other uniformed services of the United States, including the following: · Army, Navy, Marine Corps, Air Force or Coast Guard of the United States. Section A - Identifying Information Item 2: List other names under which you have been employed in the Federal government (such as a maiden name). This will help us to locate and identify all your records. Enter the address to which correspondence should be mailed. Do not enter the bank address where your payments will be deposited here; complete Section H of this application. · Cadet at the United States Military Academy, United States Air Force Academy, United States Coast Guard Academy, or Midshipman at the United States Naval Academy. Item 4: · Regular Corps or Reserve Corps of the Public Health Service after June 30, 1960. · Commissioned Officer of the National Oceanic and Atmospheric Administration after June 30, 1961 or a predecessor entity in function. Excluding the National Guard, active service in the reserve components of the uniformed services, including active duty for training, is military service. Service as a National Guard member does not meet the definition of military service for purposes of civil service retirement, except when the member is ordered to active duty in the service of the United States or performs full-time National Guard duty (as such term is defined in section 101(d) of title 10) if the National Guard duty interrupts creditable civilian service under subchapter I of chapter 84 of title 5, and is followed by reemployment in accordance with chapter 43 of title 38 that occurs on or after August 1, 1990. Section B - Federal Civilian Service Item 2: Show the agency where you performed your last Federal service. Give the bureau and/or division as well as the name of the agency and include its location (city, state). List all Federal civilian service that you have performed. Give the bureau and/or division as well as the name of the agency, along with the agency's location and the beginning and ending dates of the service. Item 3: Previous editions are not usable Instruction Page 1, RI 92-19 Revised May 2012 American LegalNet, Inc. www.FormsWorkFlow.com Item 2: Persons who performed active military service after December 31, 1956, must have paid a deposit to receive credit under the Federal Employees Retirement System (FERS) for their military service. You must have paid your deposit to your former employing agency. If you did not pay your deposit while you were still a Federal employee, you cannot pay it now. If you have military service performed after 1956, which is covered by a deposit you paid as an employee, check "Yes" and continue with this section. Items 2a and 2b will help us locate records of your payment. Indicate whether you are receiving or have applied for military retired or retainer pay (including disability retired pay and reserve retainer pay.) If you are receiving military retired pay, your military service cannot be used for retirement purposes unless your retired pay was awarded because of a service-connected disability incurred in combat with an enemy of the United States or caused by an instrumentality of war and incurred in the line of duty during a period of war as defined by Section 1101 of title 38, or was awarded under Chapter 1223, title 10, formerly Chapter 67, title 10 and title III of Public Law 80-810 (reserve retired pay at age 60 based on 20 years of active and reserve service). Otherwise, to receive credit for your military service, you must waive your military retired pay. To waive military retired pay for FERS retirement purposes, send a written request, specifying the effective date of the waiver and your Social Security Number, directly to the Military Finance Center from which you receive retired pay. Attach a copy of your letter to this application. You should mail this letter at least 60 days before your annuity will begin. Your letter might say, "I, (full name, military serial number, and Social Security Number), hereby waive my military retired pay for FERS retirement purposes, effective close of business (specify the day before annuity begins)." If y