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Get OPM SF 2803 2011

U.S. Federal Form sf-2803 Application to Make Deposit or Redeposit OMB Approved No. 3206-0134 Civil Service Retirement System To avoid a delay in processing your claim 1. Read the attached information carefully. 2. Type or print in ink. 3. Complete Part A in full and have your employing agency complete Part B. If you are not Federally employed do not complete Part B. A. To Be Completed by the Applicant Name Last first middle List all other names you have used Birthdate mm/dd/yyyy Address Number and street Department or agency in which presently or last employed Social Security Number City state and ZIP code Location of employment City and state List below in chronological order all periods of civilian service for which you would like to pay a deposit or a redeposit. branch or division where you performed the service Are deductions for civil service retirement now being withheld from your salary Yes No Periods of service Location Title of position City and state Beginning date mm/dd/yyyy If your answer is No give the date of separation from your last position under the 10. Give the dates of the period of service you want to pay for first. Signature of applicant Office of Personnel Management CSRS/FERS Handbook for Personnel and Payroll Offices Ending date Date of separation mm/dd/yyyy Dates of Period mm/dd/yyyy - mm/dd/yyyy Telephone number including area code where you can be reached during the day Edition dated June 1992 is usable. All other previous editions are not usable. Check below to indicate whether deductions were not withheld or were withheld and refunded Withheld Not withheld and refunded 2803-112 NSN 7540-00-634-4252 Standard Form 2803 Revised February 2001. Read the attached information carefully. 2. Type or print in ink. 3. Complete Part A in full and have your employing agency complete Part B. If you are not Federally employed do not complete Part B. A. To Be Completed by the Applicant Name Last first middle List all other names you have used Birthdate mm/dd/yyyy Address Number and street Department or agency in which presently or last employed Social Security Number City state and ZIP code Location of employment City and state List below in chronological order all periods of civilian service for which you would like to pay a deposit or a redeposit. If you are not Federally employed do not complete Part B. A. To Be Completed by the Applicant Name Last first middle List all other names you have used Birthdate mm/dd/yyyy Address Number and street Department or agency in which presently or last employed Social Security Number City state and ZIP code Location of employment City and state List below in chronological order all periods of civilian service for which you would like to pay a deposit or a redeposit. branch or division where you performed the service Are deductions for civil service retirement now being withheld from your salary Yes No Periods of service Location Title of position City and state Beginning date mm/dd/yyyy If your answer is No give the date of separation from your last position under the 10. .

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