FEDERAL EMERGENCY MANAGEMENT AGENCY

**Application for Waiver of Civilian/Military Annuity Reduction**

**To avoid Delays in Processing: 1) Read the following instructions
carefully; 2) Type or print clearly in ink.**

**Privacy Act Statement:** The collection of the Social Security Number
(SSN) is authorized by Executive Order 9397. Furnishing the SSN is
voluntary, but failure to do so may result in disapproval of this
request.

**INSTRUCTIONS:** Under the Federal Employee Pay Comparability Act
(FEPCA), FEMA has been granted authority to waive the civilian/military
retirement reduction during the first 120 days of a Presidential
Disaster Declaration. Waivers must be approved on a case-by-case basis
by the Director, OHRM. The following information (Part A) must be
completed by the annuitant; Part B must be approved by the DRM/FCO or
designee at the Disaster Field Office and forwarded to:

**FEMA-Emmitsburg, Maryland**

**Office of Human Resources Management**

**Field Personnel Operations Division**

**Telephone: (301) 447-1398**

**Fax: (301) 447-1299 Attn: L. Gingell**

**PART A** (This section completed by Annuitant)

[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}
[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}

Employee's Name (Please print or type) Social Security Number

*(For Identification purposes)*

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Position

This certifies that I decline employment/activation to the above
position, unless a waiver for reduction of my civilian/military

annuity is granted. I understand that this waiver will be in effect only
for the first 120 days from the date of the Presidential Disaster
Declaration. I agree to reimburse FEMA should I continue to receive full
compensation beyond the 121st day of the disaster. I understand that as
a [Federal Civilian/Military Retiree]{.underline}, a copy of my current
annuity must be attached or already on file with the

FEMA Office of Human Resources Management ***before*** this waiver can
be implemented. **Waivers will be effective on the date signed by the
authorizing official in Part B and will not be retroactive.**

Current annuity [attached]{.underline}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Yes No

Signature of Applicant Date

**PART B** (This section completed by the Disaster Field Office) DR
Number: \_\_\_**[DR-1197]{.underline}**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Presidential Declaration: \_\_\_\_\_\_\_**[\_Jan 13,
98]{.underline}**\_\_\_\_\_ 121st day after the disaster declaration:
\_\_\_**[May 13, 98]{.underline}**\_\_\_

Justification for waiver: (Briefly justify in terms of (1) the unique
skills of candidate as they apply to the disaster response effort;

\(2\) the large number of positions that must be filled; or (3) the
urgency of the response effort.)

This certifies that the employment of the annuitant listed above should
be made without a penalty to his/her civilian/military retirement
annuity, during the first 120 days of this disaster, because it is
critical to the disaster response and recovery mission of FEMA.

Effective date of activation/or hire is:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Authorizing Official Name (Print clearly or type)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Authorizing Official Signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

PART C (This section completed by the Office of Human Resources
Management)

Appointment Authority:

Approved
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Director, OHRM Date

Disapproved

Information contained herein is covered by the Privacy Act of 1974

FEMA Form 30-64 APR 97