FEDERAL BENEFITS ANALYSIS QUESTIONNAIRE


Personal
Information
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Name: e-mail: Phone:
 

Key
 Dates
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Birth Date: 

Service Computation Date: 
Transfer (CSRS to FERS) Date:   (If Applicable)
Desired Retirement Date: 
 

Spouse
Information
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Spouses' Birth Date: 
 

Employment
 and 
Retirement
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Employee Type: 
Retirement System: 

Retirement Type: 

 
CSRS Sick Leave
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Hours Saved Each Pay Period:

Hours Saved to Date:
Survivor
Benefit
Desired
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If CSRS, Enter 0% up to 100%:
%
If FERS, Enter 0%, 25% or 50%:
%
 

 

 

 

 

 

Pay
Check
Data

Employee 

Spouse 

 
Gross Pay:
FEGLI Total:
Charity:
Retirement (CSRS or FERS):
Federal Tax:
State Tax:
Social Security:
TSP Savings:
Other:
Estimated Annual Salary Increases:

Federal Employees Group Life Insurance


Basic:

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At Age 65 Reduce By:

 

Option A:

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Option B:

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Multiplier: Time(s)

Reduce to 0 After Age 65?

 

Option C:

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Multiplier: Time(s)

Reduce to 0 After Age 65?

Dependents
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  Age                 Age               Age                Age:
After 22               After 22             After 22               After 22


Thrift Savings Plan


Current Savings
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L Fund: $ C Fund: $ F Fund: $
G Fund: $ I Fund: $ S Fund: $
L Fund:

 
Investing
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Percent of Annual Salary Invested Each Year: (CSRS: 5% max, FERS: 10% max)

Distribution
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C Fund: %         F Fund: %         G Fund: %

 

 

Withdrawal
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I plan to withdraw my money:

If I selected a Monthly Amount, I will distribute my Savings as follows:

C Fund: %         F Fund: %         G Fund: %

My withdrawal will start on:


Press the SUBMIT button when you are finished. This will send this form to us for the development of your personalized Federal Employee Benefits Analysis.

 

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