1. ARMY BENEFITS CENTER-CIVILIAN
FORT RILEY, KANSAS
Screen 1- Introduction
Hello, my name is Lisa Bowers and I am a counselor from the Army Benefits Center-Civilian located at Ft. Riley, KS. This briefing is intended to help you complete the FERS disability retirement application process. Throughout the briefing you may hear me use the acronym ‘ABC’ which simply refers to the Army Benefits Center.
COMPLETING THE FEDERAL EMPLOYEES RETIREMENT SYSTEM (FERS) DISABILITY RETIREMENT APPLICATION

2. WHERE DO I FIND THE FORMS ?
Army Benefits Center-Civilian website at
Employee Benefits Information System (EBIS)
The Office of Personnel Management (OPM) at
Call a counselor ( )
Screen 2- Where do I find the forms?
First let’s go over your options for obtaining the retirement forms so that you can choose the avenue that best suits your needs. You can download the forms from the ABC website using one of two methods. The first does not require a password or pin #. From the ABC homepage simply click on the word ‘forms’ and then the word ‘retirement’ to display the available forms. The second option is to access The Employee Benefits Information System, or EBIS, which will require the use of your CAC. Once in EBIS you will click on the ‘forms’ button in order to view all of the available forms. With this option some of your personal information will auto populate into the forms saving you time. These forms can also be found at the Office of Personnel Management or OPM website. If you are unable to download and print the forms you can call a counselor at the ABC and request that we mail you the retirement forms.

3. FERS IMMEDIATE RETIREMENT FORMS
SF 3107 Application for Immediate Retirement FERS
Schedules A, B, C (if applicable)
SF Spouse’s Consent to Survivor Election (if applicable)
SF 2818 Continuation of Life Insurance Coverage
W-4P Federal Tax Withholding
DD 214 (if applicable)
OPM 1515 Military Service Deposit Election Form or proof of military deposit i.e. OPM 1514 Military Deposit Worksheet
Screen 3- FERS Immediate Retirement Forms
These forms make up the FERS immediate retirement package. Some of these forms are required and some are optional. The specific forms that you will need to complete depend on your individual circumstances. We will go over all of the forms so you can determine which ones apply to you. If you are uncertain about a particular form, please feel free to contact a counselor at the ABC so that we may help you determine which forms are applicable to your situation.

4. IDENTIFYING INFORMATION
SF 3107 – SECTION A
IDENTIFYING INFORMATION
Screen 4- SF 3107 Section A, Identifying Information
Let’s begin by looking at the SF 3107, the Application for Immediate Retirement. This form is required by all FERS employees.
Section A asks for your personal information.
1. List your name in the order of last name, first name and middle name
2. List all other names you’ve used such as your maiden name and former married names. These are names that were used while you were employed with the federal government. This will assist OPM in identifying all of your previous records.
3. Please list the address to which you want to receive correspondence. Remember, this is the address that will be used after retirement. If you are moving around the time of retirement, please list your current address and attach an additional sheet with your new address and the date you will be at the new address.
4. Please make sure that you include a good telephone number where you can be reached before and after retirement. You can also include the best time to reach you, your address and personal fax number, if available.
5. You will need to list your date of birth in order of month, day and year.
6. Please enter your social security number.
7. Indicate whether or not you are a citizen of the United States.
8. Finally, please note if this is an application for disability retirement.

5. SF 3107 – SECTION B FEDERAL SERVICE
Screen 5- SF 3107 Section B, Federal Service
Section B asks about your Federal Service
1. Please list your agency’s name such as the Department of Army, DCMA or National Guard to include your bureau or division, if known, along with the address and zip code. If you have printed your forms from EBIS this information will auto populate with the Army Benefits Center’s information. It is acceptable to leave this on your forms.
2. You do not need to list the date of your final separation for a disability retirement packet. You can leave this block blank. Please note, the date of final separation is an actual work day unless it falls on a regularly scheduled day off, for example: a weekend or an RDO (regular day off).
3. List your job title. Again if the form was printed from EBIS this will automatically populate.
3a. List your pay plan and occupational series.
4. Please indicate if you have performed honorable active duty military service. If you check ‘yes’ you will need to submit Schedule A of the SF We will go over this section of the form later in the presentation.
5. Please indicate if you are receiving or have applied for military retired pay. If you check ‘yes’ you will need to submit Schedule B of the SF We will also go over this section of the form later in the presentation.

6. SF 3107 – SECTION C MARITAL INFORMATION
Screen 6- SF 3107 Section C, Marital Information
Section C is about your marital information
1. Please indicate whether or not you are currently married by checking ‘yes’ or ‘no.’ If you checked ‘no,’ you can move on to question #2. If you checked ‘yes,’ you must complete all of the blocks in Section C and include a copy of your marriage certificate with your retirement application.
1a) list your spouse’s name
1b) list your spouse’s date of birth
1c) list your spouse’s social security number
1d) note your place of marriage
1e) please give your date of marriage
1f) please answer how you were married; if you select ‘other’ please list how the marriage was performed, for example: common law
2. If you were previously married, does your divorce decree entitle any portion of your retirement annuity to your former spouse or spouses? If yes, please provide a certified copy of the court order(s) and any amendments.

7. SF 3107 – SECTION D ANNUITY ELECTION
Screen 7- SF 3107 Section D, Annuity Election
Section D is very important! This is where you will designate your survivor benefit. Every employee MUST indicate an annuity election of some type by initialing in one of the five blocks.
1. Option 1 is a full survivor annuity and will entitle your current spouse to a benefit equal to 50% of your unreduced annuity if you pass away.
2. Option 2 is a partial survivor annuity and will entitle your current spouse to a benefit equal to 25% of your unreduced annuity if you pass away. Please note that you cannot elect this option unless you have specific written approval from your spouse. Please ensure you and your spouse complete the SF ‘Spouse’s Consent to Survivor Election’ which must be notarized and attached to this application. We will go over this form later in the presentation.
3. Option 3 will leave no survivor benefit to anyone when you pass away. Most employees who are not married will choose this election. Please note that if you are married and you elect this option you and your spouse must complete the SF ‘Spouse’s Consent to Survivor Election’ which must be notarized and attached to this application. It is important that you both understand by leaving no survivor benefit your spouse will not be eligible to continue health benefits in the event of your death.
4. Option 4 ( Which continues on the next page of the application) will leave a survivor benefit to someone who has an insurable interest in you. An insurable interest is for someone who may reasonably expect to derive a financial benefit from your continued life. The survivor annuity for an insurable interest will be equal to 55% of your annuity after your annuity has been reduced to provide this benefit. Please note it may cost up to 40% of your total annuity to provide this survivor benefit. Please read the instructions on choosing an insurable interest carefully if you are considering this option.
5. Option 5 will leave a survivor benefit for a former spouse. This election is not the same as having a court ordered survivor benefit as designated in Section C. This option is if you CHOOSE to leave a former spouse an annuity. You can leave an annuity to more than one former spouse. The survivor benefit can be 25% or 50% of your annuity. However, if you are leaving a survivor annuity for a current spouse or more than one former spouse, the combination of former spouse or spouses and or current spouse cannot total more than 50% of you annuity.

8. SF 3107 – SECTIONS E-G
INSURANCE INFORMATION, OTHER CLAIM INFORMATION AND INFORMATION ABOUT YOUR UNMARRIED DEPENDENT CHILDREN
Screen 8- SF 3107 Sections E-G, Insurance Information and Other Claim Information
Section E covers your insurance information.
Check ‘yes’ in block 1a if you meet eligibility to continue your health insurance into retirement. You will be eligible if you have had your coverage continually for the past 5 years or since your first opportunity to elect. If you meet the five year requirement through coverage under TRICARE or your spouse’s federal plan, you must provide documentation of that coverage. Please note that you still must be enrolled in FEHB on the day you retire if you are using TRICARE to meet your 5 year eligibility.
Indicate in 1b if you are required by court order to provide health benefits for your children. If so, you will need to attach a copy of the court order.
On question #2 please check ‘yes’ or ‘no’ on whether you are eligible for life insurance in retirement. To continue life insurance into retirement you again must have had your coverage continuously for the past five years or since your first opportunity to elect.
3 asks if you are enrolled in FEDVIP, the Federal Dental and Vision Insurance Program. Please see the additional note explaining that BENEFEDS may directly bill you for your premiums until your retirement has been finalized with OPM.
Finally #4 asks you whether or not you are currently enrolled in the Federal Long Term Care Insurance Program. Please see the note on the form regarding making payment arrangements with the Long Term Care Program.
Section F asks about other claim information.
1. If you are currently receiving Office of Workers’ Compensation Programs benefits or OWCP benefits, please check ‘yes.’ If you have applied but are not yet receiving benefits, please also check ‘yes.’ If you check ‘yes’ you will need to submit Schedule C of the SF We will go over this section of the form later in the presentation.
2. If you have ever filed an application for a refund of retirement contributions or to make a civilian deposit, redeposit, to participate in voluntary contributions or if you have previously applied for retirement benefits from the federal government, please check ‘yes’ and complete the rest of question #2. 2a asks you to designate which type of application you have previously submitted and 2b requests the claim number associated with that application. You may have more than one claim number so be sure to list them all.
Section G requests information about your unmarried dependent children.
Please list any unmarried dependent children under the age of 18 and their date of birth. Also list any children over the age of 18 who are incapable of self-support because of a physical or mental disability incurred before their 18th birthday. If they are incapable of self-support, please check the disabled block next to any name in which this applies.

9. DIRECT DEPOSIT AND TAX WITHHOLDING INFORMATION
SF 3107 – SECTION H
DIRECT DEPOSIT AND TAX WITHHOLDING INFORMATION
Screen 9- SF 3107 Section H, Direct Deposit and Tax Withholding Information
Section H requests information regarding your annuity payments and tax withholding.
1a) Please indicate your payment selection. If you request direct deposit, please complete the rest of this section. If you request not to have your payments be directly deposited due to choosing the Direct Express debit card offered by the Dept of Treasury or because you are residing overseas and these options are not available, please proceed to question #3.
2a-e) Enter your financial institutions routing number, your account number, type of account and your financial institution’s phone # and address. You may also attach a voided, personal check that shows the information requested.
3) Please indicate if you want federal taxes withheld from your annuity and if ‘yes’ complete block 4a and submit a W-4P Withholding Certificate for Pension or Annuity Payment Form which we will go over later in this presentation. Please note if you select “no” in Block #4 you are still responsible for those taxes to the federal government.

10. APPLICANT’S CERTIFICATION AND CHECKLIST
SF 3107 – Section I
APPLICANT’S CERTIFICATION AND CHECKLIST
Screen 10- SF 3107 Section I, Applicant’s Certification and Checklist
Section I, the Applicant’s Certification, requires your signature. We must have an original signature on this form. The applicant’s checklist is only for your use as a reminder and assistance in completing the proper forms. It is not required to be completed.

11. SCHEDULE A – MILITARY SERVICE INFORMATION
SF 3107 SCHEDULES A, B & C
SCHEDULE A – MILITARY SERVICE INFORMATION
Screen 11 - SF 3107 Schedules A, B & C- Schedule A
Schedules A, B and C are for military service and workers’ compensation. If you do not have military service or workers’ compensation, you do not need to complete these sections.
In blocks 1 through 3, please complete your name, date of birth and Social Security Number.
Schedule A needs to be completed if you have any active duty military service. List your branch of service, serial number or Social Security Number, the dates of active duty service and the last grade or rank you held in sections a through d. Please attach a copy of your DD 214s and/or copies of orders that show your active duty service.
Block 2 asks if you have paid the deposit for any military service that occurred on or after January 1st, If you have paid the deposit you must provide proof of payment with your application.

12. SCHEDULE B – MILITARY RETIRED PAY
SF 3107 SCHEDULES A, B & C
SCHEDULE B – MILITARY RETIRED PAY
Screen 12- SF 3107 Schedules A, B & C - Schedule B
Schedule B must be completed to indicate if you are receiving or have applied for military retirement or retainer pay.
A) Please check yes in block A if you are receiving or have applied for military retired or retainer pay.
B) In block B please check yes if your retired or retainer pay is due to retirement from the reserves.
C) Block C asks you to note if your pay was awarded because of a disability that was incurred while in combat or caused by an instrumentality of war and incurred while in the line of duty during a period of war. If available, please attach a copy of the award notice. Please note that this is not the same as a service connected disability that you may be receiving VA disability compensation for.
D) Finally, please note in block D whether or not you are waiving your retired or retainer pay in order to receive credit for this service in your FERS retirement. Please note that you do not need to waive your reserve retirement pay to be eligible to receive credit for your active duty military service. If you are waiving your military retired pay, please attach a copy of your waiver request and a copy of the military finance officer’s acknowledgement or approval of your waiver request.

13. SF 3107 SCHEDULES A, B & C
SCHEDULE C – FEDERAL EMPLOYEES COMPENSATION INFORMATION AND APPLICANT’S CERTIFICATION
Screen 13- SF 3107 Schedules A, B & C- Schedule C
Schedule C should be filled out for any workers’ compensation claims (OWCP). You cannot be paid for both workers’ compensation and FERS retirement.
1) In block 1 please indicate if you are receiving or have ever received OWCP benefits. In blocks A-C please provide your claim #, the dates the benefits were received as well as the type of benefit.
2) If you have applied for OWCP benefits but are not receiving them, in block 2 indicate the reason why along with your claim information.
3) In blocks 3A and B, please answer ‘yes’ or ‘no.’
Finally, make sure you sign at the bottom of the page. This form must have an original signature.

14. SF 3107-2 SPOUSE’S CONSENT TO SURVIVOR ELECTION
Screen 14 – Spouse’s Consent to Survivor Election
The SF , Spouse’s Consent to Survivor Election, needs to be completed if you are choosing to leave your spouse less than a full survivor annuity. It also needs to be completed if you are choosing to leave your former spouse a survivor benefit and you are currently married. The form needs to be signed by your spouse in the presence of a Notary and certified. You will want to make sure that your election in Part 1 matches your initialed election in Section D of the 3107 and that the date your spouse and the notary sign this form is the same.
Please note that you do not need to submit the Certified Summary or the Agency Checklist. These forms will be generated by the Army Benefits Center.

15. MILITARY SERVICE DEPOSIT ELECTION
OPM 1515
MILITARY SERVICE DEPOSIT ELECTION
Screen 15 – OPM 1515 Military Service Deposit Election
The OPM 1515, Military Service Deposit Election, needs to be completed if you have military service after Jan 1, 1957 and have not made a deposit. It needs to be completed even if you are retired military and are not electing to combine it with your civilian time.
Please enter your name, date of birth and social security number.
In the Employee Election section indicate if you want to pay a deposit for your military service and sign and date under your election.
If you have already made a military deposit, you may omit this form and provide an OPM 1514, Military Deposit Worksheet or the DFAS (Defense Finance and Accounting Services) paid in full letter.

16. SF 2818 - CONTINUATION OF LIFE INSURANCE COVERAGE
Screen 16 – SF 2818 Continuation of Life Insurance Coverage
The SF 2818, Continuation of Life Insurance Coverage, needs to be completed by anyone who currently has Federal Employee’s Group Life Insurance, or FEGLI. Please note that there should be at least one box checked under each section. These sections are: Basic, Option A, Option B and Option C. For Basic Life Insurance, you will need to choose how you want to continue it into retirement. You can take a 75% reduction, a 50% reduction or no reduction at all. The reduction you choose determines the premium that you pay. For Option A, if you are eligible, you will choose either yes or no to continue this into retirement. For Options B and C, if you are eligible, you will choose the number of multiples you wish to take into retirement and either a full reduction or no reduction. You are able to mix and match your multiples meaning some of your multiples can be selected at a full reduction and some at no reduction. If you do not have some or any of the additional options, please check the box furthest on the right stating “I don’t have” that option. Remember, you can only take into retirement what you have had continuously for the past five years. Once you have made your elections, please sign and date at the bottom of the page.
There are explanations of the effects of the different reductions on your coverage premium amounts on the instructions for the SF We also encourage you to use the FEGLI retirement calculator at the OPM website or in EBIS. This calculator allows you to depict various scenarios with different elections and obtain the associated costs.
If you still have questions about making your election, you can call the ABC and a counselor can provide you assistance.

17. W-4P – WITHHOLDING CERTIFICATE FOR PENSION OR ANNUITY PAYMENTS
Screen 17 W-4P Withholding Certificate for Pension or Annuity Payments
The W-4P, Withholding Certificate for Pension or Annuity Payments, is for your federal tax withholdings from your annuity. There is a worksheet attached on top to help you figure the allowances to elect. If you do not complete the W-4P, OPM will automatically withhold your taxes at an automatic married with 3 allowances.
If your state taxes pensions and annuities you can submit a state tax withholding form and we will forward it with your retirement application to the Office of Personnel Management.

18. FERS DISABILITY APPLICATION
Submit all of the previous forms and:
SF 3112A Applicant’s Statement of Disability
SF 3112B Supervisor’s Statement
SF 3112C Physician’s Statement
SF 3112D Agency Certification of Reassignment and Accommodation Efforts
Copy of last performance appraisal
Copy of position description
Proof of application for Social Security Disability Benefits
FEDMER Statement
Screen 18 – FERS Disability Application
If you are applying for disability retirement, you need to submit all of the previous FERS Retirement forms and the forms or documentation listed here.

19. APPLICANT’S STATEMENT OF DISABILITY
SF 3112 A
APPLICANT’S STATEMENT OF DISABILITY
Screen 19 – SF 3112 A Applicant’s Statement of Disability
The SF 3112 A, Applicant’s Statement of Disability, is completed by you, the employee. In Block 1 list your name in the order of last name, first name and middle name. In Block 2 list your date of birth in order of month, day and year. In Block number 3 you will enter your social security number. Block 4 asks you to fully describe your disability or injury such as your diagnoses and symptoms. You will describe how your disability or injury interferes with your job performance, duties and attendance in number 5. Block 6 requests that you list any additional restrictions due to your disability or injury. In block 7a list the accommodations, if any, that you have requested from your agency and in 7b check if they have granted these requests. Please note that you will need to attach any documents regarding accommodations to your application.

20. SF 3112 A (CONTINUED) Screen 20 – SF 3112 A Cont.
In Block 7c you will select your current status with your agency. Please note, if you are not currently in a pay status and are employed elsewhere you will need to list the mental and or physical requirements of that job. Block 8 asks for the date you first became disabled from your position. Check “Yes” or “No” in block 9 if you have ever been hospitalized for your disability or injury. Block 10 asks for the date of your most recent hospitalization if applicable. Please note that all FERS and CSRS Offset employees must apply for Social Security disability benefits. Block 11a asks if you have ever applied for disability benefits from Social Security and 11b asks if this documentation is attached.

21. SF 3112 A (CONTINUED) Screen 21 – SF 3112 A Cont.
Block 12 asks you to list all of the physicians that will provide documentation in support of your disability claim. Be sure to sign, date and provide a contact number where you can be reached.

22. SF 3112 B SUPERVISOR’S STATEMENT
You should ask your supervisor to complete this form. It should be returned to you to submit with the rest of the application.
Your supervisor will answer questions regarding your performance, attendance, conduct and any accommodation or reassignment efforts that have been attempted due to illness or injury.
A copy of the last performance appraisal and the employee’s position description also needs to be provided by your supervisor.
Screen 22- SF 3112 B Supervisor’s Statement
The SF 3112 B, Supervisor’s Statement, is a form that you need to provide to your supervisor to complete. Your supervisor will answer the questions regarding your performance, attendance, conduct and any accommodation or reassignment that has been attempted due to your illness or injury. Your supervisor will also need to provide a copy of your most recent performance appraisal and your position description.

23. SF 3112 C PHYSICIAN’S STATEMENT
Screen 23 –SF 3112 C Physician’s Statement
The SF 3112 C, Physician’s Statement, will be filled out by you, the employee, and given to each physician who will be providing medical documentation in support of your disability application. We encourage you to gather all of the medical documentation from your physician(s) and submit the entire packet together rather than having each physician submit documentation separately. This ensures that your application is complete when you send it to the ABC which will expedite the application process. The specific medical documentation requested from your physician is on the second page of instructions for this form. Please make sure we receive the SF 3112 C with your packet. To complete this form list your name in the order of last name, first name and middle name in block 1. In block 2 you will need to list your date of birth in order of month, day and year. Please enter your Social Security number in block 3. In block 4 please list the ABC address which can be found on the last slide of this presentation. You will sign and date block number 5.

24. SF 3112 D AGENCY CERTIFICATION OF REASSIGNMENT AND ACCOMMODATION EFFORTS
You should ask your servicing Civilian Personnel Advisory Center, CPAC, or Human Resources Office, HRO, to complete this form.
Once completed it should be returned to you to submit with the rest of the application.
The CPAC or HRO will answer questions about the agency’s accommodation and/or reassignment efforts.
Screen 24 – SF 3112 D - Agency Certification of Reassignment and Accommodation Efforts
The SF 3112 D, Agency Certification of Reassignment and Accommodation Efforts, is completed by your local Civilian Personnel Advisory Center, CPAC, or Human Resources Office, HRO. Once the CPAC or HRO has completed the form they should return it to you so you can submit it in your disability retirement packet.

25. FEDMER SOCIAL SECURITY DISABILITY ELIGIBILITY STATEMENT
Screen 25 – FEDMER Social Security Disability Eligibility Statement
If you are a FERS employee applying for a disability retirement you will need to complete the FEDMER Social Security Disability Eligibility Statement. Put your name and Social Security number on the form. In the first section you will indicate if you are currently receiving Social Security disability benefits or if you filed and are awaiting a decision from their office. If you selected box #1 or 2 you will need to sign that area and provide documentation with your application.

26. FEDMER SOCIAL SECURITY DISABILITY ELIGIBILITY STATEMENT
Screen 26 – FEDMER Social Security Disability Eligibility Statement
If you have not applied for Social Security disability benefits you will select box #3. You will then need to apply for Social Security disability following the directions on the form. The Social Security office will provide you with an application receipt. You must provide that receipt and the FEDMER statement to the ABC in order for your disability application to be processed. If you have applied for Social Security disability benefits and were denied, you will need to provide the denial letter and FEDMER statement to the Army Benefits Center with your application.

27. BENEFICIARY FORMS SF 2823 Designation of Beneficiary-
Federal Employees’ Group Life Insurance Program
SF 3102 Designation of Beneficiary-
Federal Employees Retirement System
TSP-3 Thrift Savings Plan-Designation of Beneficiary
Screen 27 – Optional Forms
Beneficiary forms are not required for retirement. If you know who is listed on your beneficiary forms, you do not need to complete new ones. Also if you have never completed beneficiary forms and you are happy with the order of precedence by law, you do not need to complete new ones. However, if there is any doubt as to whether you have ever filled out designation of beneficiary forms in the past or you are unsure of who is listed, you may want to fill out new forms. Designation of beneficiary forms can be completed at any time. Beneficiary forms can be obtained on the ABC website. From the ABC home page click on the word “forms” and then “beneficiary”. Please note that the TSP-3 Thrift Savings Plan Designation of Beneficiary form should be mailed directly to the address noted on the form. This form is not valid until it reaches the Thrift Savings Plan office.

28. WHERE DO I SEND THE FORMS ?
All forms and documentation should be submitted to:
ARMY BENEFITS CENTER-CIVILIAN
305 MARSHALL AVE
FORT RILEY, KS
Screen 28 – Where Do I Send the Forms
Please mail your disability retirement application and all supporting documentation to the address noted, which is: Army Benefits Center–Civilian, 305 Marshall Avenue, Fort Riley, KS Once your application is received at ABC, it will be assigned to a disability retirement counselor. After the counselor has worked your preliminary disability retirement they will call you to go over your annuity estimate and answer any questions you might have.
This concludes our briefing on Completing the FERS Disability Retirement Application process. If you have any questions or require our assistance please do not hesitate to call the Army Benefits Center to speak with a benefits counselor. Our number is Counselors are available from 7 am to 5 pm Central Time. We look forward to serving you and ensuring a smooth transition into retirement.
REMEMBER: We must have original forms!