+------------------------+------------------------------+-------------+
| **RETIREMENT PLANNING  | #                            | ###### Che  |
| ELEMENTS**             |                              | ck here whe |
|                        | #                            | n completed |
|                        | **OFFICER RESPONSIBILITIES** |             |
+------------------------+------------------------------+-------------+
| (A) **Retirement       | Attend Retirement Seminar(s) | ######      |
|     Seminar:**         | after 15 years continuous    |             |
|                        | active duty. More than one   | Date:       |
|                        | may be needed.               | \_\_\_      |
|                        |                              | \_\_\_\_\_\ |
|                        |                              | _\_\_\_\_\_ |
+------------------------+------------------------------+-------------+
| (B) **Planning         | #### A list o                | Date:       |
|     Elements for       | f important things to consid | \_\_\_      |
|     Consideration:**   | er when planning retirement: | \_\_\_\_\_\ |
|                        |                              | _\_\_\_\_\_ |
| > **Hints:**           | a.  A Survivor Benefit Plan  |             |
|                        |     (SBP)                    | Date:       |
| -   Consider Financial |                              | \_\_\_      |
|     Planning as soon   | b.  A Direct Deposit Form    | \_\_\_\_\_\ |
|     as possible        |     for retirement pay       | _\_\_\_\_\_ |
|                        |                              |             |
| -   Prepare retirement | c.  An Employees Withholding | Date:       |
|     documents in       |     Allowance Certificate    | \_\_\_      |
|     advance            |                              | \_\_\_\_\_\ |
|                        | d.  A Request for Voluntary  | _\_\_\_\_\_ |
| > **See Pamphlet #24   |     State Income Tax         |             |
| > -- "Information on   |     Withholding from         | Date:       |
| > Commissioned         |     Retirement Pay           | \_\_\_      |
| > Officers Retirement" |                              | \_\_\_\_\_\ |
| > for complete         | e.  A request to             | _\_\_\_\_\_ |
| > information          |     Establish/Change Mailing |             |
| > regarding retirement |     Address form             | Date:       |
| > planning.**          |                              | \_\_\_      |
|                        | f.  Choosing a Home of       | \_\_\_\_\_\ |
|                        |     Selection (HOS)          | _\_\_\_\_\_ |
|                        |                              |             |
|                        | g.  The Officer's Leave      | Date:       |
|                        |     Record                   | \_\_\_      |
|                        |                              | \_\_\_\_\_\ |
|                        | h.  A complete Exit Physical | _\_\_\_\_\_ |
|                        |     Examination              |             |
|                        |                              | Date:       |
|                        | i.  Terminal Leave and       | \_\_\_      |
|                        |     Lump-Sum Leave Payments  | \_\_\_\_\_\ |
|                        |                              | _\_\_\_\_\_ |
|                        | j.  Thrift Savings Plan      |             |
|                        |     (TSP) or Financial       | Date:       |
|                        |     Planning                 | \_\_\_      |
|                        |                              | \_\_\_\_\_\ |
|                        | k.  Turning in Active Duty   | _\_\_\_\_\_ |
|                        |     ID Card                  |             |
|                        |                              | Date:       |
|                        |                              | \_\_\_      |
|                        |                              | \_\_\_\_\_\ |
|                        |                              | _\_\_\_\_\_ |
|                        |                              |             |
|                        |                              | Date:       |
|                        |                              | \_\_\_      |
|                        |                              | \_\_\_\_\_\ |
|                        |                              | _\_\_\_\_\_ |
|                        |                              |             |
|                        |                              | Date:       |
|                        |                              | \_\_\_      |
|                        |                              | \_\_\_\_\_\ |
|                        |                              | _\_\_\_\_\_ |
+------------------------+------------------------------+-------------+
| (C) *                  | a)  **Requesting             | Date:       |
| *Application/Effecting |     Permission:** Officer    | \_\_\_      |
|     Retirement:**      |     must have greater that   | \_\_\_\_\_\ |
|                        |     20 and less than 30      | _\_\_\_\_\_ |
|                        |     active duty years. Memo  |             |
|                        |     on Agency letterhead     |             |
|                        |     must be sent up Chain of |             |
|                        |     Command to receive       |             |
|                        |     permission to            |             |
|                        |     voluntarily retire.      |             |
+------------------------+------------------------------+-------------+
|                        | b)  **Requesting             | Date:       |
|                        |     Retirement:** After      | \_\_\_      |
|                        |     approval received,       | \_\_\_\_\_\ |
|                        |     officer completes form   | _\_\_\_\_\_ |
|                        |     PHS 1373 "Separation of  |             |
|                        |     Commissioned Officer"    |             |
|                        |     and forwards to          |             |
|                        |     Retirement Coordinator.  |             |
+------------------------+------------------------------+-------------+

+------------------------+------------------------------+-------------+
| **RETIREMENT PLANNING  | #                            | ###### Che  |
| ELEMENTS**             |                              | ck here whe |
|                        | #                            | n completed |
|                        | **OFFICER RESPONSIBILITIES** |             |
+------------------------+------------------------------+-------------+
| (D) **Travel and       | Contact Agency/OPDIV travel  | Date:       |
|     Transportation     | representative and Shipping  | \_\_\_      |
|     Allowances:**      | Officer for details related  | \_\_\_\_\_\ |
|                        | to retirement move and       | _\_\_\_\_\_ |
|                        | correct forms used for       |             |
|                        | reimbursements. Currently,   | Date:       |
|                        | retiring officers are        | \_\_\_      |
|                        | authorized one final move    | \_\_\_\_\_\ |
|                        | within the Continental       | _\_\_\_\_\_ |
|                        | United States (CONUS) that   |             |
|                        | include(s):                  | Date:       |
|                        |                              | \_\_\_      |
|                        | a.  Mileage                  | \_\_\_\_\_\ |
|                        |                              | _\_\_\_\_\_ |
|                        | b.  Per Diem                 |             |
|                        |                              | Date:       |
|                        | c.  Shipment of Household    | \_\_\_      |
|                        |     Goods (HHG)              | \_\_\_\_\_\ |
|                        |                              | _\_\_\_\_\_ |
|                        | d.  1 year of Non-Temporary  |             |
|                        |     Storage (NTS) at **point |             |
|                        |     of origin**              |             |
|                        |                              |             |
|                        | -   Allowances include       |             |
|                        |     dependents               |             |
|                        |                              |             |
|                        | -   All HHG not put into NTS |             |
|                        |     may use 90 days of       |             |
|                        |     Temporary Storage at     |             |
|                        |     **point of destination** |             |
|                        |                              |             |
|                        | -   Additional assistance    |             |
|                        |     and information          |             |
|                        |     available at             |             |
|                        |     [http://dcp.psc          |             |
|                        | .gov](http://dcp.psc.gov/) - |             |
|                        |     under "Services"         |             |
+------------------------+------------------------------+-------------+
| (E) **Retirement       | Upon retirement, officers    | Date:       |
|     Benefits:**        | may have the use of the      | \_\_\_      |
|                        | following benefits:          | \_\_\_\_\_\ |
|                        |                              | _\_\_\_\_\_ |
|                        | a.  Uniformed Medical        |             |
|                        |     Treatment Facilities     |             |
|                        |     (MTF)                    |             |
|                        |                              |             |
|                        | b.  Enrollment in TRICARE    |             |
|                        |                              |             |
|                        | c.  Medicare at age 65       |             |
|                        |                              |             |
|                        | d.  Use of Military          |             |
|                        |     Facilities               |             |
|                        |     (Commissaries,           |             |
|                        |     Exchanges, Recreational  |             |
|                        |     Areas etc.)              |             |
|                        |                              |             |
|                        | e.  Space-A Travel           |             |
|                        |                              |             |
|                        | It is the officer's          |             |
|                        | responsibility to check and  |             |
|                        | review all benefits offered  |             |
|                        | after retirement.            |             |
+------------------------+------------------------------+-------------+
| (F) **Survivor Benefit | Plan provides annuity to     | Date:       |
|     Plan (SBP):**      | spouse and dependents upon   | \_\_\_      |
|                        | the officer's death. Contact | \_\_\_\_\_\ |
|                        | retirement coordinator for   | _\_\_\_\_\_ |
|                        | enrollment form and          |             |
|                        | information.                 |             |
|                        |                              |             |
|                        | a.  Complete and submit form |             |
|                        |     PHS-5150 "Survivor       |             |
|                        |     Benefit Plan election    |             |
|                        |     Certificate" prior to    |             |
|                        |     the date of retirement.  |             |
+------------------------+------------------------------+-------------+

+------------------------+------------------------------+-------------+
| **RETIREMENT PLANNING  | #                            | ###### Che  |
| ELEMENTS**             |                              | ck here whe |
|                        | #                            | n completed |
|                        | **OFFICER RESPONSIBILITIES** |             |
+------------------------+------------------------------+-------------+
| (G) **Veterans Affairs | Review the following         | Date:       |
|     Benefits (VA):**   | benefits from the VA:        | \_\_\_      |
|                        |                              | \_\_\_\_\_\ |
|                        | a.  VA Hospitals             | _\_\_\_\_\_ |
|                        |                              |             |
|                        | b.  Life Insurance           |             |
|                        |                              |             |
|                        | c.  Disability Compensation  |             |
|                        |                              |             |
|                        | d.  Educational Assistance   |             |
|                        |                              |             |
|                        | e.  Home Loan Guarantee      |             |
|                        |                              |             |
|                        | f.  Death Benefits           |             |
|                        |                              |             |
|                        | g.  Dependency and Indemnity |             |
|                        |     Compensation (DIC)       |             |
+------------------------+------------------------------+-------------+
| (H) **Employment and   | Review the CCPM concerning   | Date:       |
|     Political          | employment after retirement. | \_\_\_      |
|     Activity:**        | Some restrictions apply when | \_\_\_\_\_\ |
|                        | conflicts of interest are    | _\_\_\_\_\_ |
|                        | involved. Contact the agency |             |
|                        | ethics counselor for more    |             |
|                        | details.                     |             |
+------------------------+------------------------------+-------------+
| (I) **Assistance after | Designate an individual who  | Date:       |
|     Retirement:**      | will act as the personal     | \_\_\_      |
|                        | representative in the event  | \_\_\_\_\_\ |
|                        | the officer becomes          | _\_\_\_\_\_ |
|                        | incapable of acting on his   |             |
|                        | or her own behalf.           |             |
+------------------------+------------------------------+-------------+
| (J) **Social           | #######                      | Date:       |
|     Security:**        |                              | \_\_\_      |
|                        | Contact Social Security      | \_\_\_\_\_\ |
|                        | representative concerning    | _\_\_\_\_\_ |
|                        | benefits. Information        |             |
|                        | available in the booklet     |             |
|                        | "Your Social Security"       |             |
|                        | available at                 |             |
|                        | [http://www.s                |             |
|                        | sa.gov](http://www.ssa.gov/) |             |
|                        | or phone 1-800-772-1213.     |             |
+------------------------+------------------------------+-------------+
| (K) **Former Spouses'  | #######                      | Date:       |
|     Protections Act    |                              | \_\_\_      |
|     (FSPA):**          | If former spouse is          | \_\_\_\_\_\ |
|                        | involved, review section     | _\_\_\_\_\_ |
|                        | concerning "Division of      |             |
|                        | Retired Pay" for             |             |
|                        | commissioned officers, or    |             |
|                        | contact Commissioned Corps   |             |
|                        | Support Services (CCSS) at   |             |
|                        | 301-594-2963 for more        |             |
|                        | information.                 |             |
+------------------------+------------------------------+-------------+
| (L) **Survivor         | #######                      | Date:       |
|     Benefits and       |                              | \_\_\_      |
|     Assistance:**      | Review Annuity Benefits      | \_\_\_\_\_\ |
|                        | and/or Funeral and Burial    | _\_\_\_\_\_ |
|                        | Expense benefit chart in     |             |
|                        | Pamphlet #24 -- "Information |             |
|                        | on Commissioned Corps        |             |
|                        | Retirement"                  |             |
+------------------------+------------------------------+-------------+