Federal Employee Retirement Questionnaire

Federal Retirement Questionnaire

When our office receives your form submission you will be contacted to set up an appointment, if you have any questions please contact our office at 800-826-5824.
Agency and Location
Retirement Training Date and Instructor
Name
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Spouse's Name
If applicable
Spouse's date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Dependent Children
Employee Type:
FERS Transfer Date
Applicable only for FERS Transfers
Are you planning to leave a survivor benefit for your spouse?
If you answered 'No' above, is your spouse a federal employee?
Current Salary
Law Enforcement Include AUO
Unused Sick Leave Hours
Unused Annual Leave
Estimated Age 62 Monthly Social Security Benefit
Can be found at SSA.gov, if unknown leave blank
Employee's Service Computation Date
For Law Enforcement Agents Only: Date you entered law enforcement
Employee's desired retirement date:
Does your Service Computation Date include military time?
Dates in military if applicable:
Example: 06/01/1990-12/01/1994
Do you have military time that needs to be purchased?
FERS employees must make a deposit for military time to be calculated in their SCD for retirement purposes.
Did you have a break in service?
Did you receive a refund of retirement contributions for a break in service? If yes, did you make a redeposit for this time?
If applicable please elaborate.
Federal Employee Group Life Insurance
Do you have Basic Life Coverage?
Do you have Option A Coverage?
Do you have Option B Coverage?
How many multiples of Option B do you have?
A federal employee can carry 1 to 5 multiples of Option B coverage.
Do you have Option C Coverage? This coverage is on your spouse and eligible children.
How many multiples of Option C do you have?
A federal employee can carry 1 to 5 multiples of Option C coverage.
Thrift Savings Plan
Current TSP balance?
Roth TSP balance
You may not have any savings in the after-tax or Roth TSP.
Traditional TSP balance

Your Current TSP Allocation:

Rows	C Fund	G Fund	S Fund	I Fund	F Fund	Lifecycle Funds
Current Allocation

Please indicate which Lifecycle Funds you have and the amount in each below:
EX. $115,000 in L Income Fund, $50,000 L 2035
Current Traditional TSP Contributions:
How much are you currently contributing to the TSP biweekly. With the new 'Spillover' method there is no need to differentiate between regular contributions and catch-up contributions. The 2023 IRA Deferral limit is $22,500 and for those age 50 and over $7,500 catch-up.
Current Roth TSP Contributions:
How much are you currently contributing to the TSP biweekly. With the new 'Spillover' method there is no need to differentiate between regular contributions and catch-up contributions. The 2023 IRA Deferral limit is $22,500 and for those age 50 and over $7,500 catch-up.

Your Current Contribution Allocation:

Rows	C Fund	G Fund	S Fund	I Fund	F Fund	Lifecycle Funds
Current Contribution Allocation

Please let us know which L Funds you have and the contribution amount allocated to each.
Ex. 25% L 2030 Fund, 10% L 2050 Fund
Do you have any private savings or life insurance you would like us to consider when discussing your retirement income needs? This is voluntary.
Do you have any specific concerns you want to discuss or any entries above you would like to elaborate on?
If you would like to include any files to your submission they can be uploaded here:

Cancelof
Should be Empty:

Federal Retirement Questionnaire

Federal Employee Group Life Insurance

Thrift Savings Plan