Attachment F

Standard Form 2806-1, Notice of Correction of Individual Retirement Record

(Reflecting Correct Rates of Pay)

Standard Form 2806-1

Rev February 1980

Office of Personnel Management

NOTICE OF CORRECTION OF INDIVIDUAL

RETIREMENT RECORD

CIVIL SERVICE RETIREMENT SYSTEM

Office of Personnel Management

Retirement and Insurance Service

Washington, DC 20415

Please correct the Standard Form 2806 for the former employee named below as indicated:

NAME OF EMPLOYEE

1Ronald P. Johnson

DATE OF BIRTH

11/15/44

SOCIAL SECURITY NUMBER

444-44-4444

AGENCY

ABC

PAYROLL OFFICE NO.

XX 00 0001

LOCATION (Incl. ZIP code)

Washington, DC 20415

REASON FOR CORRECTION

To correct service history.

FISCAL DATA

CURRENT YEAR 1998 TOTAL CUMULATIVE DEDUCTIONS

DATA SHOWN ON STANDARD FORM 2806

CORRECTED DATA

AMOUNT OF OVERSTATEMENT OF TOTAL DEDUCTIONS

SERVICE HISTORY DATA

(Name, date of birth, appointment, separation, promotion, etc.--specify which)

DATA SHOWN ON STANDARD FORM 2806 CORRECTED DATA

2 310/11/98 Pay Adj (PL 105-277) $40,360.32

Annualized

01/03/99 Pay Adj $41,820.48 Annualized

01/02/99 Pay Adj $43,767.36 Annualized

01/02/00 Pay Adj $43,767.36 Annualized

03/31/00 Ret Mand $43,767.36 Annualized

STANDARD FORM 2806 FORWARDED TO OPM ON REGISTER 4 OPM 00-03

DATED April 22, 2000

CERTIFICATION

I certify that the corrections shown above are correct.

SIGNATURE 5

DATE September 5, 2000 TITLE For Chief, Budget and Finance Division

1Name of employee, date of birth, social security number, name of agency, payroll office number and location.

Fiscal data reported on SF 2806.

Corrected fiscal data.

2Service history data reported on SF 2806

3Corrected service history data

 4Register number and date SF 2806 was forwarded to Office of Personnel Management.

5Certify as to correctness of data reported.

Attachment F

(24 Hour Shift Firefighter)

Documenting Firefighter Overtime Pay on SF 2806 and SF 3100 per PL 105-277

Date of Birth Soc.Sec.No. Agency Payroll Office Location Payroll Office No.

Mo Day Yr 222 22 2222

03 25 45

Do Not Use ABC Central Washington, DC XX 000001

FISCAL RECORD

Base Pay(3)

Remarks(4)

Year(5)

Calendar Year SalaryDeductions(6)

AccumulativeTotal SalaryDeductions(7)

Remarks(8)

35,155 GS-06/08 0081 Incl 25% Prem

Pay

69,403.91 Bal Forward

36,175 GS-06/08 0081 Incl 25% Prem

Pay

1997 2,628.60 72,032.51 7.50% Deds

37,152.50 GS-06/09 0081 Incl 25% Prem

Pay

1998 2,704.65 74,737.16 7.50% Deds

240,360.32 3GS-06/09 0081 Incl

Annualized salary

1999 3,241.05 77,978.21 7.75% Deds

41,820.48 GS-06/09 0081 Incl

Annualized salary

2000 864.40 78,842.61 7.90% Deds

43,767.36 GS-06/09 0081 Incl

Annualized salary

Deductions and Service Certified Correct

43,767.36 GS-06/09 0081 Incl

Annualized salary

5 Tour 72 hrs wk

4USL Expires 07/26/00

d Transfers, SF 2807

Individual Retirement Record U.S. Office of Personnel Management

7

 to include allowable Overtime under PL 105-277

column #4, and note Annualized salary shown

on a rotating tour enter the AVERAGE weekly tour)

ere computed using the General Schedule Locality Pay Tables for "Rest of United States". Employee has a regularly scheduled workweek of 72 hours

 creditable for retirement purposes should be shown in column 3.
Attachment F

(40+ Hour Shift Firefighter)

Documenting Firefighter Overtime Pay on SF 2806 and SF 3100 per PL 105-277

Date of Birth Soc.Sec.No. Agency Payroll Office Location Payroll Office No.

Mo Day Yr 333 33 3333

03 10 45

Do Not Use ABC Central Washington,

DC

 XX 000001

FISCAL RECORD

Base Pay(3)

Remarks(4)

Year(5)

Calendar Year SalaryDeductions(6)

AccumulativeTotal SalaryDeductions(7)

Remarks(8)

30,691.25 GS-05/7 0081 Incl 25% Prem

Pay

27,111.40 Bal Forward

31,580.00 GS-05/7 0081 Incl 25% Prem

Pay

1997 455.62 27,567.02 1.30% Deds

232,818.24 3 GS-05/7 0081 Incl

Annualized salary

1998 468.81 28,035.83 1.30% Deds

33,712.64 GS-05/8 0081 Incl Annualized

salary

1999 619.59 28,655.42 1.55% Deds

34,902.40 GS-05/8 0081 Incl Annualized

salary

2000 177.83 28,833.25 1.70% Deds

36,533.12 GS-05/8 0081 Incl Annualized

salary

Deductions and Service Certified Correct

36,533.12 GS-05/8 0081 Incl Annualized

salary

4USL Expires 03/12/01 5Tour 56 hrs wk

d Transfers, SF 3103

Individual Retirement Record U.S. Office of Personnel Management

7

 to include allowable Overtime under PL 105-277

column #4, and annotate "Annualized Salary"

on a rotating tour enter the AVERAGE weekly tour)

 computed using the General Schedule Locality Pay Tables for "Rest of United States".

orkweek of 56 hours

 creditable for retirement purposes should be shown in column 3.
Attachment F

1“SUPPLEMENTAL”

Documenting additional contributions for firefighters under PL 105-277

Date of Birth Soc.Sec.No. Agency Payroll Office Location Payroll Office No.

Mo Day Yr 444 44 4444

11 15 44

Do Not Use ABC Central Washington, DC XX 000001

FISCAL RECORD

Base Pay(3)

Remarks(4)

Year(5)

Calendar YearSalary Deductions(6)

AccumulativeTotal SalaryDeductions(7)

Remarks(8)

31998 4 6.32 6.32 6Deductions understated for 1999 31.97 38.29 1998, 1999, and 2000. 2000 7.89 46.18 SF 2806 forwarded 04/22/005Deductions and Service Certified Correct with Reg. No. OPM 00-03

understated deductions.

d Transfers, SF 2807

Individual Retirement Record U.S. Office of Personnel Management

L"

nderstated

nformation

orrection