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Get OPM RI 20-97 2019-2024

Requester s name and address Return this completed form to address below Print Form Save Form Clear Form RI 20-97 Revised May 2013 Previous editions are not usable. United States Office of Personnel Management Retirement Operations Center Boyers Pennsylvania 16017 Estimated Earnings During Military Service Instructions Use a separate RI 20-97 for each branch of service. Attach DD 214 or the equivalent and any available records of pay or promotions. The pay center cannot provide estimated earnings without verification of service. The requester must complete blocks 1 through 10 and block 19. Visit the Defense Finance and Accounting Service website for the address to send this form and request your earnings at www. dfas. mil/civilianemployees/customerservice. 1. Name Last first middle 2. Other names used 3. Social Security Number 4. Date of birth mm/dd/yyyy 5. All military service numbers 6. Branch of service The uniformed services must provide Federal employees estimated basic pay for military service they performed after December 31 1956. This is needed to make a deposit to the Civil Service Retirement and Disability Fund for retirement credit. Please provide the estimated basic pay earned by the person named above. 7. Signature of requester 8. Relationship to person named 9. Date Person named is requester Survivor Other specify 10. Active military service after December 31 1956 Dates indicated below must be based on DD 214 or equivalent certification* From mm/dd/yyyy To 12. If period of service began before and ended after December 31 1956 enter date service actually began* mm/dd/yyyy 11. Authorized Official of Retired Pay Center completes blocks 11 through 18. Do not provide estimated earnings for any period of service prior to January 1 1957. Rate of Basic Pay Earnings Type of Discharge 13. Lost time None Number of days Inclusive dates 14. Signature of authorized official furnishing estimate 15. Date 17. Typed name of authorized official 16. Telephone number including area code 18. Title of authorized official 19. Attach DD 214 or the equivalent and any available records of pay or promotions. The pay center cannot provide estimated earnings without verification of service. The requester must complete blocks 1 through 10 and block 19. Visit the Defense Finance and Accounting Service website for the address to send this form and request your earnings at www. The requester must complete blocks 1 through 10 and block 19. Visit the Defense Finance and Accounting Service website for the address to send this form and request your earnings at www. dfas. mil/civilianemployees/customerservice. 1. Name Last first middle 2. Other names used 3. Social Security Number 4. dfas. mil/civilianemployees/customerservice. 1. Name Last first middle 2. Other names used 3. Social Security Number 4. Date of birth mm/dd/yyyy 5. All military service numbers 6. Branch of service The uniformed services must provide Federal employees estimated basic pay for military service they performed after December 31 1956.

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