CSRS Payroll Office Reporting of FERS i 

Withholdings and Contributions
 

Chapter 80
 

Table of Contents
 

Subchapter 80A CSRS and FERS 

Part 80A1 General Information 

Section 80A1.1-1 Overview ......................................... 1
 

A. Introduction .................................................. 1
 

B. Topics Covered ............................................... 2
 

C. Organization of Subchapter ........................................ 2
 

D. Statement of Authority ........................................... 2
 

Section 80A1.1-2 Definitions ......................................... 3
 

A. Check and Non-Check Agencies ..................................... 3
 

B. Government On-Line Accounting Link System (GOALS) .................... 3
 

C. On-Line Payment and Collection System (OPAC) ......................... 3
 

D. Reporting Periods ............................................. 3
 

E. Retirement and Insurance Transfer System (RITS) ......................... 4
 

F. Salary Offset ................................................. 4
 

G. Transaction Date .............................................. 4
 

Part 80A2 Reporting Requirements 

Section 80A2.1-1 Rules Governing the Submission of Reports of Deductions and 

Contributions. ................................................ 5
 

A. Who Reports ................................................. 5
 

B. When to Report ............................................... 5
 

C. Numbering Schemes for Reports .................................... 5
 

D. Supplemental Payrolls ........................................... 6
 

E. Correction of Errors in Reports ..................................... 6
 

Section 80A2.1-2 Completing the Report Header ........................... 8
 

A. General ..................................................... 8
 

B. Address .................................................... 8
 

C. Telephone Number ............................................. 8
 

D. To: ....................................................... 8
 

E. Payroll Office Number ........................................... 9
 

F. Report Number ............................................... 9
 

G. Month Reported on Statement of Transactions ............................ 9
 

H. Date Payroll Paid .............................................. 9
 

I. Pay Period From .............................................. 9
 

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ii CSRS Payroll Office Reporting of FERS 

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Chapter 80
 

J. Pay Period To ............................................... 10
 

K. Check Attached .............................................. 10
 

L. Credit to OPM Receipt Account .................................... 10
 

M. Agency Account Charged ........................................ 10
 

N. Signature of Authorized Officer .................................... 10
 

O. Date ...................................................... 10
 

Part 80A3 Life Insurance Portion 

Section 80A3.1-1 General .......................................... 11
 

A. General .................................................... 11
 

Section 80A3.1-2 Reporting Life Insurance Deductions and Contributions ......... 12
 

A. Basic Life Line ............................................... 12
 

B. Standard­Option A, Additional­Option B, Family­Option C Lines .............. 12
 

C. Post-Retirement Line ........................................... 13
 

D. Total Life Insurance Line ........................................ 14
 

Part 80A4 Health Benefits Portion 

Section 80A4.1-1 General .......................................... 15
 

A. General .................................................... 15
 

Section 80A4.1-2 Completing the Health Benefits Portion .................... 16
 

A. Regular Line ................................................ 16
 

B. Temporary Continuation of Coverage Line ............................. 16
 

C. Total Health Benefits Line ....................................... 17
 

Section 80A4.1-3 Completing the Report of Deductions and Contributions for
 

Health Benefits by Enrollment Code ................................ 18
 

A. General .................................................... 18
 

B. Completing SF 2812-A Header Information ............................ 18
 

C. Completing the Withholdings and Contributions Portion .................... 19
 

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Withholdings and Contributions
 

Chapter 80
 

Part 80A5 Retirement Portion 

Section 80A5.1-1 General (CSRS) .................................... 21
 

A. General .................................................... 21
 

B. CPDF Codes ................................................ 21
 

Section 80A5.1-2 Completing the CSRS Portion .......................... 23
 

A. All Categories Line ............................................ 23
 

B. Salary Offset-Reemployed Annuitants Line ............................. 23
 

C. Military and Civilian Service Credit Line .............................. 23
 

Section 80A5.1-3 General (FERS) .................................... 25
 

A. General .................................................... 25
 

B. CPDF Codes ................................................ 25
 

Section 80A5.1-4 Completing the FERS Portion .......................... 26
 

A. Regular FERS Employees Line .................................... 26
 

B. Military Reserve Technicians Line .................................. 26
 

C. Special Line ................................................. 27
 

D. Salary Offset-Reemployed Annuitants Line ............................. 27
 

E. Military Deposit Line .......................................... 28
 

Section 80A5.1-5 Completing the Totals on SF 2812 ........................ 29
 

A. Total Retirement Line .......................................... 29
 

B. Grand Total Line ............................................. 29
 

Part 80A6 Submitting the Report 

Section 80A6.1-1 Submitting the Report ................................ 30
 

A. Reporting .................................................. 30
 

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iv CSRS Payroll Office Reporting of FERS 

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Chapter 80
 

Subchapter 80B Job Aids 

Section 80B1.1-1 Blank Forms for Local Reproduction and Sample Completed
 

Forms .................................................... 31
 

Blank Forms for Local Reproduction -­

Report of Withholdings and Contributions for Health Benefits, 

Life Insurance and Retirement, SF 2812 .............................. 32
 

Report of Withholdings and Contributions for Health Benefits, 

Life Insurance and Retirement, SF 2812 L ............................. 33
 

Report of Withholdings and Contributions for Health Benefits 

By Enrollment Code, SF 2812-A ................................... 34
 

Sample Completed Forms -­

Report of Withholdings and Contributions for Health Benefits, 

Life Insurance and Retirement, SF 2812 -- Example ....................... 35
 

Report of Withholdings and Contributions for Health Benefits 

By Enrollment Code, SF 2812-A -- Example ........................... 36
 

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Chapter 80 

Subchapter 80A CSRS and FERS 

Part 80A1 General Information 

Section 80A1.1-1 Overview 

A.	 Introduction This Chapter discusses the reporting requirements for employee payroll 

withholdings and agency contributions for retirement and health and life 

insurance premiums. These reports were formerly submitted solely via 

Standard Form (SF) 2812, Report of Withholdings and Contributions for 

Health Benefits, Life Insurance and Retirement. In 1991, however, OPM 

completed its development of the Retirement and Insurance Transfer System 

(RITS) and many agency payroll offices are now submitting this 

information to OPM electronically. 

Effective with the first pay period paid in August 1991, all agency payroll 

offices capable of accessing the U.S. Department of Treasury's Government 

On-line Accounting Link System (GOALS) were required to use RITS to 

transmit retirement, health benefits and life insurance monies and 

information to OPM. For these agencies, the hard-copy SF 2812/2812-A is 

no longer acceptable. Exceptions are granted only to those agency payroll 

offices that make their own disbursements or submit their Federal employee 

benefit monies to OPM by check. 

Federal agencies making their own disbursements should still remit their 

withholdings and contributions information via the SF 2812. The nonFederal offices that have employees subject to the retirement, health or life 

insurance programs must remit a check payable to OPM and their 

withholdings and contributions information via the new Standard 

Form 2812 L to OPM's lockbox for crediting. 

Agencies that need assistance with RITS should contact the Financial 

Management Division (FMD) staff on (202) 606-0666. The data provided 

in the reports, whether transmitted electronically or by hard-copy 

SF 2812/2812 L/2812-A, is still essentially the same; therefore, this 

Chapter will continue to serve as the source of any general information an 

agency may need concerning the data that must be provided in these 

reports. 

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Withholdings and Contributions
 

Chapter 80
 

Section 80A1.1-1 Overview (Cont.) 

B.	 Topics Covered This subchapter covers: 

•	 Reporting requirements and procedures for completing general 

information portions of the reports. 

•	 Specific instructions on completing the following portions of the 

reports: 

- The life insurance portion. 

- The health benefits portion. 

- The retirement portion, including separate instructions for 

employees covered under the Civil Service Retirement System 

(CSRS) and the Federal Employees Retirement System (FERS). 

- Instructions on submitting the reports and references to additional 

forms and information that may also be used. 

C. Organization of 

Subchapter 

This subchapter has six parts. 

PART NAME OF PART PAGE

 80A1 Overview 1

 80A2 Report Requirements 5

 80A3 Life Insurance Portion 11

 80A4 Health Benefits Portion 15

 80A5 Retirement Portion 21

 80A6 Submitting the Reports 30 

D.	 Statement of 

Authority 

This Chapter and its contents are based on the laws and regulations cited 

below. 

•	 United States Code: 5 U.S.C. chapters 83, 84, 87, and 89 

•	 Code of Federal Regulations: 5 CFR Parts 831, 841, 870-873, and 

890-891 

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Chapter 80
 

Section 80A1.1-2 Definitions 

A.	 Check and NonCheck Agencies 

B.	 Government OnLine Accounting 

Link System 

(GOALS) 

"Check" agencies are those agencies that do not maintain a Treasury 

account (for example, Agricultural Extension Service offices), and must 

submit a check to OPM in the net amount shown on SF 2812 L. "Noncheck" agencies are those agencies that transfer funds to OPM via the 

Department of the Treasury. Most "non-check" agencies report via RITS. 

GOALS is the U.S. Department of Treasury's government-wide electronic 

accounting system. All Federal agencies capable of accessing GOALS must 

use RITS to transmit withholding and contribution monies and information 

to OPM. 

C.	 On-Line Payment 

and Collection 

System (OPAC) 

For non-check agencies under RITS, OPAC automatically transfers funds 

equal to the total withholdings and contributions reported via RITS on the 

payroll paid date. 

D. Reporting 

Periods 

Reporting period refers to the pay period being reported. There are five 

types of pay periods used in computing employee pay, deductions, and 

contributions. Agencies may only report the withholdings and contributions 

for a single type of pay period on each transmission or report. If any 

payroll office has employees under more than one of these types of pay 

periods, it must transmit or report each type of pay period separately. 

The pay periods are as follows: 

• Biweekly: Employees are paid once every two weeks. 

• Weekly: Employees are paid once every week. 

• Monthly: Employees are paid once every month. 

• Semi-monthly: Employees are paid twice every month. 

•	 Twenty-eight Days, Employees are paid once every 28 days. 

or 

"Four Weekly":	 This payroll type is used by the Department of 

Labor's Office of Workers' Compensation 

Programs (OWCP). 

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Chapter 80
 

Section 80A1.1-2 Definitions (Cont.) 

D. Reporting 

Periods (Cont.) 

Note: Employees receiving benefits from OWCP are the only individuals 

paid on the special 28 day/4-weekly pay period. OWCP submits a 

separate report covering deductions for life insurance and health 

benefits from the individuals' OWCP benefits. 

E. Retirement and 

Insurance 

Transfer System 

(RITS) 

RITS is an electronic method of remitting and reporting withholdings and 

contributions for the Federal Employees Group Life Insurance Program, the 

Federal Employees Health Benefits Program, the Civil Service Retirement 

System, and the Federal Employees Retirement System. 

F. Salary Offset In the case of a reemployed annuitant, a salary offset is the reduction in a 

reemployed annuitant's pay in an amount equal to the annuity allocable to 

the period of actual employment. The offset amount must be submitted to 

OPM and reported in the appropriate format. (See Chapter 100, 

Reemployed Annuitants, to determine whether the annuity continues during 

employment and for other detailed guidance on reemployed annuitants.) 

G. Transaction Date Transaction date (month and year only) refers to the date that funds are 

actually transferred from the agency appropriation or fund symbol. OPM 

receives payments from agencies by two methods -- checks and non-check 

transfers. "Non-check" agencies using RITS do not need to provide this 

information since the transfer is done automatically. "Check" agencies 

must post a transaction date on the report. (See section 80A2.1-2, 

paragraph G, for additional information on posting transaction dates.) 

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Chapter 80
 

Part 80A2 Reporting Requirements 

Section 80A2.1-1 Rules Governing the Submission of Reports of Withholdings and 

Contributions. 

A.	 Who Reports All agencies that employ civilian employees who participate in the 

Government-wide life insurance, health benefits, or retirement programs 

must report and remit to OPM the amount of withholdings and 

contributions for these programs either electronically or via SF 2812. 

Non-Federal organizations with employees entitled to Federal benefits 

report via SF 2812 L with payment to OPM's lockbox for crediting. 

Organizations or agencies whose payroll is cross-serviced (for example, by 

the National Finance Center) normally would not provide a withholdings 

and contributions report to OPM; instead, the report is generally prepared 

by the organization providing payroll services. 

B.	 When to Report The payroll office must report the withholdings and contributions for 

employee life and health insurance premiums, and retirement coverage to 

OPM no later than the date the payroll is paid. (See section 80A1.1-2, 

paragraph B, for information on reporting periods.) 

C.	 Numbering 

Schemes for 

Reports 

For "check" agencies, submitting payroll offices must number each report 

in consecutive order for each calendar year. The first payroll period of the 

calendar year is numbered in the following format: 

YY-001 

YY refers to the last two digits of the calendar year and 001 is the first 

report by the payroll office for that year. For example, 93-001 is the first 

report of the calendar year 1993 and will cover those employees paid on the 

first pay period paid in 1993. 

For "non-check" agencies, RITS will automatically number the report for 

the agency. The RITS reports will be numbered in the following format: 

YY-##A 

YY refers to the last two digits for the calendar year and ##A represents 

two numerical and one alphabetical character assigned by RITS. 

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Chapter 80 

Section 80A2.1-1 Rules Governing the Submission of Reports of Withholdings and 

Contributions (Cont.) 

C. Numbering 

Schemes for 

Reports (Cont.) 

Number reports sequentially throughout the calendar year, ending with the 

last payroll period paid in the calendar year. It is important that there is no 

break in the numbering of reports. A new sequential series starts for the 

first pay period paid in the next calendar year. 

No two reports may use the same report number unless one of them is a 

supplemental report as described in paragraph D below. Separate report 

numbers are required even if two pay period types end on the same date 

(see section 80A1.1-2, paragraph B). The pay period that began first takes 

precedence and receives the first available report number. The next report 

number is assigned to the pay period that began later. 

D. Supplemental 

Payrolls 

1. Only agencies reporting via RITS may submit a report of additional 

retirement, health and life insurance withholdings and contributions for 

the most recent payroll reporting period by submitting a supplemental 

report. For non-check agencies an erroneous underreporting of 

withholdings and contributions should normally be corrected by 

including the additional amounts in the report for the next 

corresponding payroll reporting period as described in paragraph E2 

below. 

2. If an agency needs to prepare a supplemental payroll, prepare a report 

to be submitted to OPM. The report should show the same payroll 

period, payroll paid date, report number, and transaction date as shown 

on the regular report. 

E. Correction of 

Errors in Reports 

Whenever an error occurs in a report, payroll offices must take one of the 

following actions to correct the error. 

1. If the report does not balance (that is, the totals on the report are 

incorrect), establish the correct totals, prepare a corrected report using 

the same payroll period, payroll paid date, report number, and 

transaction date as shown on the regular report and give OPM's Funds 

Control Branch notice of the correction both by telephone and in 

writing. 

Office of Personnel Management 

Funds Management Branch 

Post Office Box 582 

Washington, DC 20044-0582 

Telephone: FTS (202) 606-0670 

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Withholdings and Contributions 

Chapter 80 

Section 80A2.1-1 Rules Governing the Submission of Reports of Withholdings and 

Contributions (Cont.) 

E. Correction of 

Errors in Reports 

(Cont.) 

2. If the report balances but the amounts shown on the report are 

incorrect, add unreported amounts (or deduct overstated amounts) in the 

next regular report for the same type of payroll reporting period (see 

section 80A1.1-2, paragraph B). No explanation or notification to 

OPM is necessary in this case. 

EXAMPLE: If an agency erroneously omits $1,500 of withholdings 

and $1,500 of contributions for a category on the report for a monthly 

payroll period, then the agency will increase the same category by 

$1,500 each for withholdings and contributions on the next regularly 

scheduled monthly payroll report. 

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CSRS and FERS Handbook April, 1998 
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Withholdings and Contributions
 

Chapter 80
 

Section 80A2.1-2 Completing the Report Header 

A.	 General This section describes the procedures used to complete the header section of 

the report. Refer to the sample report in Subchapter B. 

The header section consists of the first 10 to 14 blocks at the top of the 

form. These blocks are labeled: 

1. Address 

2. Telephone Number 

3. To 

4. Payroll Office Number 

5. Report Number 

6. Month Reported on Statement of Transactions* 

7. Date Payroll Paid 

8. Pay Period: From 

9. Pay Period: To 

10. Check Attached* 

11. Credit to OPM Receipt Account (24x8135.8)* 

12. Agency Account Charged* 

13. Signature of Authorized Officer 

14. Date 

*NOTE: These blocks are not included on the SF 2812 L. 

B.	 Address Provide the complete mailing address of the agency making the report in 

this block, including department, bureau, location, and zip code. 

C.	 Telephone 

Number 

Provide the telephone number of a point of contact in the payroll office. 

D. To: Send all reports electronically or to the address pre-printed on the 

applicable forms. 

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Chapter 80
 

Section 80A2.1-2 Completing the Report Header (Cont.) 

E.	 Payroll Office 

Number 

Enter the payroll office number, which is an eight digit number. All 

reports must contain this eight digit payroll office number. 

A directory of payroll office numbers is maintained by OPM. Agencies 

may notify OPM regarding payroll office numbers by contacting: 

Office of Personnel Management 

Retirement and Insurance Service 

Funds Management Branch, Room 3H25 

1900 E Street, NW. 

Washington, DC 20415-0001 

Telephone: FTS (202) 606-0670 

F. Report Number 

G. Month Reported 

on Statement of 

Transactions 

Enter the report number in this block as described in section 80A2.1-1, 

paragraph C. 

The transaction date (see section 80A1.1-2, paragraph D) is reported in the 

following format: 

MM/YY 

H. Date Payroll Paid 

MM refers to the numeric calendar month (that is, 01 for January). YY 

refers to the last two digits of the calendar year. 

Enter the date that the payroll for the period is actually paid. The report 

should be received no later than this date. The format for the entry in this 

block is: 

MM-DD-YY 

I. Pay Period From 

MM is the number of the month; DD is the number of the day of the 

month; YY is the last two digits of the calendar year. 

Enter the first day of the pay period being reported in the same format as in 

the Date Payroll Paid. 

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Chapter 80 

Section 80A2.1-2 Completing the Report Header (Cont.) 

K. Check Attached Mark this block with an "X" only if the agency is sending a check payable 

to OPM for the total amount reflected on the SF 2812. Agencies submitting 

reports electronically or via SF 2812 L do not have this data element on 

their reports. 

J. Pay Period To Enter the last day of the pay period being reported in the same format as the 

Date Payroll Paid. 

L. Credit to OPM 

Receipt Account 

Non-check agencies show that funds are being transferred to OPM via the 

Department of the Treasury. The account number shown in this block is 

also the same account number that will be credited on the agency's 

Statement of Transactions. (See Part 80A6 below.) Check agencies do not 

use this data element. 

M. Agency Account 

Charged 

Non-check agencies enter the appropriation symbol of the account that is the 

source of the funds to be transferred to the OPM in the amount of the total 

reflected on the report. This account must be shown as an outlay for the 

same amount on the Statement of Transactions. (See Part 80A6 below.) 

Check agencies do not use this data element. 

N. Signature of 

Authorized 

Officer 

Enter the original signature of the authorized administrative or certifying 

officer from the payroll office/agency submitting the report. 

O. Date Insert the date the report is signed by the authorized administrative or 

certifying officer. 

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Chapter 80 

Part 80A3 Life Insurance Portion 

Section 80A3.1-1 General 

A.	 General All payroll offices must report to OPM for each payroll reporting period 

when withholdings and contributions are made towards life insurance. (See 

The Federal Employees Group Life Insurance Handbook for Personnel and 

Payroll Offices for a discussion of costs, coverage, entitlement, etc.) 

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Chapter 80 

Section 80A3.1-2 Reporting Life Insurance Withholdings and Contributions 

A.	 Basic Life Line 1. The cost of basic life insurance is shared by the employee and the 

government. The report contains column entries for both 

withholdings and contributions for basic life insurance. 

2.	 Report the total amount of employee withholdings for basic life 

insurance in the space provided under the Withholdings column 

heading. 

3.	 Report the total amount of agency contributions for basic life 

insurance in the space provided under the Contributions column 

heading. 

B.	 StandardOption A, 

AdditionalOption B, 

Family­ Option C 

Lines 

1. Employees may elect to purchase three additional types of optional 

life insurance. Employees pay the entire cost of these optional types 

of coverage. (See The Federal Employees Group Life Insurance 

Handbook for Personnel and Payroll Offices for a discussion of this 

coverage.) The available options are called: 

• Standard­Option A 

• Additional­Option B 

• Family­Option C 

2.	 Report on the appropriate line for each optional life insurance 

category any withholdings made toward each of the optional types of 

FEGLI coverage. 

NOTE:	 For agencies with their own retirement systems (such as the 

Foreign Service, the District of Columbia Government, or the 

Railroad Retirement System), report the total amount of 

premiums withheld from the annuities of retirees for optional life 

insurance by option/type (that is, Options A, B, or C) on a 

separate report using the payroll office number assigned 

specifically for annuitants. Never combine employee reporting 

data with annuitant reporting data. 

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Chapter 80
 

Section 80A3.1-2 Reporting Life Insurance Withholdings and Contributions (Cont.) 

C. Post-Retirement 

Line	 

1. Employees who retire may elect to continue 25 percent, 50 percent, 

or 100 percent of their basic life insurance coverage under the FEGLI 

Program during retirement. The cost is withheld from their annuities. 

2.	 Report the total amount of withholdings for post-retirement life 

insurance coverage on the Post-Retirement line if your agency 

administers a retirement system that has annuitants from whose 

annuities post-retirement life insurance premiums are being withheld. 

Agencies and other organizations (such as the Foreign Service, the 

District of Columbia Government, or the Railroad Retirement 

System) with their own retirement systems, report post-retirement life 

insurance withholdings to OPM on a monthly basis. 

3.	 Retirees who separated on or after January 1, 1990, must pay the 

same premium (referred to as supplemental premium) as active 

employees for basic life insurance coverage between retirement and 

age 65. In addition, those who elect at retirement to retain higher 

levels of coverage after reaching age 65 must pay an additional 

premium (referred to as regular premium) throughout their 

retirement. Retirement systems -­

•	 Report the regular premiums on the Post-Retirement line. 

•	 Report the supplemental premiums in the Withholdings 

column on the Basic Life line. 

•	 Enter the amount that OPM should pay from its special 

appropriation account in the Contributions column of the 

Basic Life line. 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
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Withholdings and Contributions
 

Chapter 80
 

Section 80A3.1-2 Reporting Life Insurance Withholdings and Contributions (Cont.) 

D. Total Life 

Insurance Line	 

1. Total the dollar amount of the withholdings for each type of life 

insurance category reported. Enter this figure on the Total Life 

Insurance line under the Withholdings column. 

2.	 Total the amount of contributions reported for the basic life category 

and enter this figure on the Total Life Insurance line under the 

Contributions column. 

3.	 Calculate the total of all life insurance withholdings and contributions 

by adding the amount of the withholdings and contributions entered 

for the Total Life Insurance category. Enter the resulting amount on 

the Total Life Insurance line under the Total column heading. 

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Withholdings and Contributions 

Chapter 80 

Part 80A4 Health Benefits Portion 

Section 80A4.1-1 General 

A.	 General This part contains information for completing the health benefits portion of 

the reports. This part also contains information and procedures for 

completing and submitting the SF 2812-A, Report of Withholdings and 

Contributions for Health Benefits by Enrollment Code and its RITS 

electronic counterpart. (See The Federal Employees Health Benefits 

Handbook for Personnel and Payroll Offices for detailed guidance on the 

Federal Employees Health Benefits Program (FEHB).) 

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CSRS and FERS Handbook	 April, 1998 
16 CSRS Payroll Office Reporting of FERS 

Withholdings and Contributions 

Chapter 80 

Section 80A4.1-2 Completing the Health Benefits Portion 

A.	 Regular Line 1. Calculate the total health benefits withholdings for all regular 

enrollees during the reporting period covered. 

NOTE: Agencies must pay the Government contribution for an 

employee as soon as it becomes due whether the employee is 

in a pay or nonpay status. (See The Federal Employees 

Health Benefits Handbook for Personnel and Payroll Offices, 

for a discussion of the treatment for employees in a leavewithout-pay status.) 

2.	 With the exception of those eligible under the Temporary 

Continuation of Coverage (TCC) provision addressed in paragraph B, 

calculate total payments from special groups of individuals eligible to 

enroll in the FEHB program at their own cost -- namely, temporary 

employees (5 U.S.C. 8906a) and former spouses (5 U.S.C. 8905(c)) ­

- during the reporting period. (See The Federal Employees Health 

Benefits Handbook for Personnel and Payroll Offices or The Federal 

Employees Health Benefits Handbook for Personnel and Payroll 

Offices and related letters.) 

•	 Report withholdings for temporary employees only for pay 

periods for which they are paid. 

•	 Report payments from former spouses for the appropriate payroll 

pay period type (for example, biweekly, semi-monthly, etc.). 

3.	 Enter the total enrollee withholdings and payments (derived by 

combining the amounts in steps 1 and 2 above) on the Regular line 

under the Withholdings column heading. 

4.	 Enter the total contributions made by the agency office for health 

benefits for the reporting period covered on the Regular line under the 

Contributions column heading. There are no agency contributions for 

temporary employees or former spouses. These individuals pay the 

total health benefits premium. 

B. Temporary 

Continuation of 

Coverage Line 

Individuals eligible under the Temporary Continuation of Coverage (TCC) 

provision (5 U.S.C. 8905a) pay the total health benefit premium (enrollee 

and Government share) plus an administrative add-on of two percent of 

premiums. 

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Chapter 80
 

Section 80A4.1-2 Completing the Health Benefits Portion (Cont.) 

B. Temporary 

Continuation of 

Coverage Line 

(Cont.) 

Enter the full amount of TCC premiums (102 percent) collected during the 

reporting period covered on the TCC line under the Withholdings column. 

Show the 2-percent administrative add-on as a negative under the 

Contributions column on the same line (unless adjustments cause the 

amount to be reported as a positive figure). 

C. Total Health 1. Total the amount of enrollee withholdings and contributions under the 

Benefits Line	 Withholdings column and enter this amount on the Total Health 

Benefits line under the Withholdings column heading. 

2.	 Total the amount of agency contributions under the Contributions 

column and enter this amount on the Total Health Benefits line under 

the Contributions column heading. 

3.	 Calculate the total of all health benefits withholdings and 

contributions by adding the amounts derived in steps 1 and 2 above. 

Enter the resulting amount on the Total Health Benefits line under the 

Total column heading. 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
18 CSRS Payroll Office Reporting of FERS 

Withholdings and Contributions 

Chapter 80 

Section 80A4.1-3 Completing the Report of Withholdings and Contributions for Health 

Benefits by Enrollment Code 

A.	 General Complete the Report of Withholdings and Contributions for Health Benefits 

by Enrollment Code (SF 2812-A or RITS counterpart). Transmit this data 

to OPM electronically or submit a hard copy SF 2812-A to OPM with the 

SF 2812 or SF 2812 L, as appropriate, any time withholdings and 

contributions are made for health benefits. Reporting rules for the 

SF 2812-A report follow those for the hard copy SF 2812, SF 2812 L or 

the electronic facsimile regarding payroll reporting periods. (See section 

80A1.1-2, paragraph B.) 

B.	 Completing 

SF 2812-A 

Header 

Information 

The header of SF 2812-A requires completing nine blocks. In general, 

payroll offices complete the header blocks of the SF 2812-A consistently 

with the header blocks of the SF 2812/SF 2812 L or the electronic 

facsimile. A description of each block follows. A sample SF 2812-A 

report is provided in Subchapter B. 

1. Department or Establishment 

Show the agency or establishment name as stated on the first line of 

the address block on SF 2812-A report. 

2. Bureau, Division, or Office 

State the bureau, division, or office in the agency that is responsible 

for completing and submitting SF 2812-A report to OPM. 

3. Address 

Show the mailing address of the office responsible for preparing 

SF 2812-A report. 

4. Payroll Office Number 

Show the same 8-digit payroll office number as was entered on the 

SF 2812, SF 2812 L, or the electronic facsimile. 

5. Report Number 

Show the same report number used on the Report of Withholdings 

and Contributions. This report number is the most important 

identifying link between the SF 2812/SF 2812 L or the electronic 

facsimile and the SF 2812-A report. 

Information in this chapter has not been updated since August 1996 

August, 1996	 CSRS and FERS Handbook 
 CSRS	 Payroll Office Reporting of FERS 19 

Withholdings and Contributions
 

Chapter 80
 

Section 80A4.1-3 Completing the Report of Withholdings and Contributions for Health 

Benefits by Enrollment Code (Cont.) 

B.	 Completing 

SF 2812-A 

Header 

Information 

(Cont.) 

6. Pay Period From 

Show the same pay period beginning date as shown on the Report of 

Withholdings and Contributions the SF-2812-A report supplements. 

Never use a different payroll period on the SF 2812-A report. 

7.	 Pay Period To 

Show the same pay period ending date as shown on the Report of 

Withholdings and Contributions the SF-2812-A report supplements. 

8.	 Date Payroll Paid 

Show the identical payroll paid date shown in the header of the Report 

of Withholdings and Contributions supplemented by the SF 2812-A 

report. 

9.	 Telephone Number 

Show the same agency telephone number for the preparing office 

shown on the Report of Withholdings and Contributions. 

C.	 Completing the 1. Enrollment codes are used to identify the specific health benefit plans 

Withholdings and and options available through the Federal Employee Health Benefits 

Contributions (FEHB) Program. Each FEHB Open Season, new or different plans 

Portion may be added and some existing plans may be deleted or changed. 

Each year, OPM publishes a new list of enrollment codes for 

participating plans. 

2.	 Provide the total withholdings and contributions as a combined 

amount for each health benefit enrollment code. This combined 

amount and the enrollment code for each participating plan is entered 

as a separate line on the SF 2812-A report. 

NOTE:	 Negative amounts are sometimes reported, when necessary, to 

show adjustments to a particular code due to a previous 

overreporting. 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
20 CSRS Payroll Office Reporting of	 FERS 

Withholdings and Contributions
 

Chapter 80
 

Section 80A4.1-3 Completing the Report of Withholdings and Contributions for Health 

Benefits by Enrollment Code (Cont.) 

C.	 Completing the 3. The number enrolled columns are used for semi-annual headcount 

Withholdings and reporting in March and September. (See Chapter 85, Headcounts, for 

Contributions additional information about headcount procedures.) The number 

Portion (Cont.) enrolled is not required on non-headcount SF 2812-A reports. 

4.	 The total of the withholdings and contributions for each enrollment 

code must equal the total of health benefits withholdings and 

contributions reported on the electronic facsimile, the SF 2812, or the 

SF 2812 L. 

Information in this chapter has not been updated since August 1996 

August, 1996	 CSRS and FERS Handbook 
 CSRS Payroll Office Reporting of
 21 

Withholdings and Contributions
 

Chapter 80
 

Part 80A5 Retirement Portion 

Section 80A5.1-1 General (CSRS) 

A.	 General This section contains information and procedures for reporting the 

withholdings and contributions for employees under the Civil Service 

Retirement System (CSRS) on the CSRS retirement portion. 

The retirement portion is divided between withholdings and contributions 

for Civil Service Retirement System (CSRS) and Federal Employees 

Retirement System (FERS) employees. As with life insurance and health 

benefits reporting rules, retirement withholdings and contributions are 

reported to OPM only for employees in the same payroll reporting period. 

(See section 80A1.1-2, paragraph B.) 

B. CPDF Codes The CSRS portion refers to employees who are categorized on the Central 

Personnel Data File (CPDF) under the following codes: 

CODE DESCRIPTION 

RATE OF 

WITHHOLDING 

FROM PAY AS OF 1992

 1 Regular employee under CSRS 7 percent

 6 Special employee under CSRS 7.5 or 8 percent

 C Regular employee under CSRS 

Offset 

.8 percent 

(see note below)

 E Special employee under CSRS 

Offset 

1.3 or 1.8 percent 

(see note below)

 R Senior officials (regular) under 

CSRS with Social Security 

coverage 

7 percent

 T Senior officials (special) under 

CSRS with Social Security 

coverage. 

8 percent 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
22 CSRS Payroll Office Reporting of 

Withholdings and Contributions 

Chapter 80 

Section 80A5.1-1 General (CSRS) (Cont.) 

B. CPDF Codes NOTE: The withholding rate for CSRS Offset employees is determined by 

(Cont.)	 subtracting the current Social Security (OASDI) deduction rate 

from the statutory rate of CSRS withholdings (7 percent or 7.5 or 

8 percent for special groups). 

Once annual basic pay reaches the Social Security maximum taxable wage 

base for the calendar year (adjusted annually), CSRS withholdings increase 

to the full rate. (See Chapter 30, Employee Deductions and Agency 

Contributions, for a complete discussion of "basic pay" used to establish 

employee withholdings and agency contributions.) 

Information in this chapter has not been updated since August 1996 

August, 1996	 CSRS and FERS Handbook 
 CSRS Payroll Office Reporting of
 23 

Withholdings and Contributions
 

Chapter 80
 

Section 80A5.1-2 Completing the CSRS Portion 

A.	 All Categories 

Line 

B.	 Salary OffsetReemployed 

Annuitants Line 

Report the retirement withholdings and contributions for all employees with 

the CPDF codes listed in section 80A5.1-1, paragraph B, in the All 

Categories Line under the CSRS portion. 

1. Withholdings 

The amount of withholdings is equal to the mandatory amounts based 

on the rates shown in section 80A5.1-1, paragraph B (rate times 

amount of basic pay paid). (See Chapter 30.) 

2. Contributions 

Contributions by agencies for CSRS employees generally are equal to 

the employee withholding rate. However, agencies with CSRS Offset 

employees must contribute an amount equal to the full employee 

withholding rate that applies to non-Offset employees (7, 7.5, or 8 

percent according to CPDF code), regardless of the amount of 

employee withholdings or OASDI taxes. (See Chapter 30.) 

Salary offset amounts are paid to the retirement fund by the employing 

agency, and should be reported under the Contributions column for the 

payroll reporting period applicable to the salary being offset. (See 

Chapter 100 for more information on reemployed annuitants.) 

C.	 Military and 

Civilian Service 

Credit Line 

Report the combined total amount of CSRS military deposits and CSRS 

civilian service credit payments on the same line under the Withholdings 

column. 

1. Military Service Credit 

Employees receive credit for periods of post-1956 military service by 

paying a deposit equal to 7 percent of the military basic pay received 

plus any applicable interest. (See Chapter 22, Creditable Military 

Service, and Chapter 23, Service Credit Payments for Post-1956 

Military Service, for the procedures and rules governing military 

service deposits and the crediting of military service.) 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
24 CSRS Payroll Office Reporting of 

Withholdings and Contributions 

Chapter 80 

Section 80A5.1-2 Completing the CSRS Portion (Cont.) 

C.	 Military and 2. Civilian Service Credit 

Civilian Service 

Credit Line Report withholdings for reemployed annuitants under CSRS who elect 

(Cont.) to have withholdings deducted from their pay to receive additional 

retirement annuity credit. Compute the amount of withholdings by 

taking the applicable rate (7, 7.5, or 8 percent, or .8, 1.30, or 1.8 for 

CSRS Offset employees, according to CPDF code) times the total 

basic pay paid before deducting the offset for annuity. (See 

Chapter 100.) 

Civilian service credit payments are normally made directly to OPM; 

however, there are certain types of civilian service credit payments that 

are made to the employing agency. Report the following types of them on 

this line. 

•	 Pre-1969 National Guard technician service credit payments 

authorized by Public Law 99-661; and 

•	 Service credit payments for Cadet nurse service credit authorized by 

Public Law 99-638. 

•	 Retroactive employee retirement contributions required when an 

employee's unjustified or unwarranted personnel action is canceled 

and the employee's back pay entitlement does not cover the amount of 

the employee retirement deduction. 

NOTE:	 The amount of the deposit (including interest) for National Guard 

technicians under Public Law 99-661 and Cadet nurses under 

Public Law 99-638 was computed by OPM for collection by the 

individual's employing agency. There is no accompanying 

agency contribution for either type of service credit. 

The deposit (without an interest charge) for retroactive employee retirement 

contributions due to an unjustified or unwarranted personnel action is to be 

computed by the employing agency based on the amount of deductions the 

employee would have had taken from pay if there had been no unjustified or 

unwarranted personnel action and is to be accompanied by the matching 

agency contributions for such service. 

No other type of deposit for civilian service credit may be reported. (See 

Chapter 20, Creditable Civilian Service, for a discussion of credit for 

National Guard technicians and Cadet nurses.) 

Information in this chapter has not been updated since August 1996 

August, 1996	 CSRS and FERS Handbook 
 CSRS Payroll Office Reporting of 25 

Withholdings and Contributions 

Chapter 80 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook April, 1998 
26 Payroll Office Reporting of	 FERS 

Withholdings and Contributions
 

Chapter 80
 

Section 80A5.1-3 General (FERS) 

A.	 General This section contains information and procedures for completing the 

withholdings and contributions entries for the Federal Employee Retirement 

System (FERS) retirement portion. 

NOTE:	 See Chapter 30 for detailed guidance on employee deductions and 

agency contributions under FERS. 

B.	 CPDF Codes The FERS portion covers employees who are categorized under the 

following CPDF codes: 

CPDF CODE DESCRIPTION 

EMPLOYEE 

WITHHOLDING 

RATES AS OF 1992 

K Regular FERS Employee 

.8 percent 

N Military Reserve 

Technicians .8 percent 

L 

Special FERS Employee 

(Air Traffic Controller) 1.3 percent 

M Special FERS Employee 

(Law Enforcement 

Officer/Firefighter) 

1.3 percent 

NO CODE Special FERS 

Members of Congress 1.8 percent 

NO CODE 

Special FERS 

Congressional Employees 1.3 percent 

Information in this chapter has not been updated since August 1996 

August, 1996	 CSRS and FERS Handbook 
Payroll Office Reporting of FERS 27 

Withholdings and Contributions 

Chapter 80 

Section 80A5.1-4 Completing the FERS Portion 

A. Regular FERS Report the retirement withholdings and contributions for all regular FERS 

Employees Line	 employees, including reemployed regular FERS annuitants, with the CPDF 

codes listed in section 80A5.1-3, paragraph B, in the Regular line under the 

FERS portion. 

1. Withholdings 

Base the withholdings for regular FERS employees on the rates 

shown in section 80A5.1-3, paragraph B (rate times amount of basic 

pay paid). Base the withholdings for reemployed regular FERS 

annuitants on total basic pay before any offset for annuity. 

2. Contributions 

Report total agency contributions for regular FERS employees (that 

is, total normal cost contributions less employee withholdings). 

Include contributions for reemployed regular FERS annuitants (with 

contributions based on total basic pay before any offset for annuity). 

NOTE: Do not use this report for employee withholdings and 

agency contributions for Social Security. 

B. Military Reserve 

Technicians Line 

Report the retirement withholdings and contributions for all Military 

Reserve Technicians (MRT's) on the Military Reserve Technicians line. 

Under FERS, MRT's have special retirement provisions. (See Chapter 46, 

Special Retirement Provisions for Law Enforcement Officers, Firefighters, 

Air Traffic Controllers, and Military Reserve Technicians, for the 

provisions that apply to Military Reserve Technicians.) The normal cost 

for MRT's is different from the regular FERS normal cost, and is reported 

separately. 

1. Withholdings 

The withholdings rate for MRT's is the same as for regular FERS 

employees. 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
28 Payroll Office Reporting of	 FERS 

Withholdings and Contributions
 

Chapter 80
 

Section 80A5.1-4 Completing the FERS Portion (Cont.) 

B. Military Reserve 2. Contributions 

Technicians Line 

(Cont.) Contributions for MRT's equal the amount of the normal cost 

contributions for MRT's less the amount of employee withholdings. 

C.	 Special Line Report the retirement withholdings and contributions for special employee 

groups on the Special Line under the FERS portion. 

Special employee groups under FERS (that is, law enforcement officers and 

firefighters (CPDF Code M), air traffic controllers (CPDF Code L), 

congressional employees (no CPDF Code), and Members of Congress 

(no CPDF Code), by law, have an additional one-half percent of basic pay 

withheld. The normal cost for each special employee group is also different 

from that for regular FERS employees. 

If more than one type of special group employee received pay during the 

payroll reporting period, combine the total amount of withholdings and 

agency contributions for each different type of group, and report the 

combined amount on the Special line. 

1. Withholdings 

Withholdings for these special employee groups are based on the rates 

shown in section 80A5.1-3, paragraph B. (See Chapter 30.) 

2. Contributions 

Compute the contributions for special group employees by subtracting 

employee withholdings from total normal cost contributions. Use the 

normal cost/contribution rate in effect for the specific type of special 

employee group. 

D.	 Salary OffsetReemployed 

Annuitants Line 

Report the amount of the salary offset under the contributions column 

heading for the Salary Offset-Reemployed Annuitants line. (See 

Chapter 100 for additional information on reemployed annuitants.) 

FERS retirees rehired after January 7, 1988, must have their basic pay 

offset by the amount of their FERS annuity. 

Information in this chapter has not been updated since August 1996 

August, 1996	 CSRS and FERS Handbook 
Payroll Office Reporting of FERS 29 

Withholdings and Contributions 

Chapter 80 

Section 80A5.1-4 Completing the FERS Portion (Cont.) 

E.	 Military Deposit Report the total amount of military deposits under the Withholdings column 

Line heading for the Military Deposit line. 

FERS employees receive retirement annuity credit for post-1956 military 

service by making a deposit for such service. The deposit is equal to 3 

percent of military basic pay plus applicable interest. (See Chapters 22 

and 23 for a discussion of creditable military service and military deposit 

procedures.) 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
30 Payroll Office Reporting of FERS 

Withholdings and Contributions 

Chapter 80 

Section 80A5.1-5 Completing the Totals on SF 2812 

A. Total Retirement 

Line 

Total the retirement portion of the report by adding down all entries under 

the respective withholdings and contributions column headings. Enter the 

totals in the appropriate column on the Total Retirement line of the form. 

Add together the total withholdings and contributions for retirement, and 

enter the result on the Total Retirement line under the Total column 

heading. 

B.	 Grand Total Line Add the total withholdings for life insurance, health benefits, and retirement 

shown on the report, and enter this combined amount on the Grand Total 

line under the Withholdings column heading. 

Add the total contributions for life insurance, health benefits, and retirement 

shown on the report and enter the amount on the Grand Total line under the 

Contributions column heading. 

Add the grand total withholdings and the grand total contributions, and 

enter this sum on the Grand Total line under the Total column heading. 

The amount of withholdings and contributions for the period must equal the 

sum of the total amounts for life insurance, health benefits, and retirement. 

Information in this chapter has not been updated since August 1996 

August, 1996	 CSRS and FERS Handbook 
 CSRS	 Payroll Office Reporting of FERS 31 

Withholdings and Contributions
 

Chapter 80
 

Part 80A6 Submitting the Report 

Section 80A6.1-1 Submitting the Report 

A. Reporting 1. "Check" Agencies 

For "check" agencies, the report should be received no later than 

the date the payroll is paid (for the period being reported). OPM 

should also receive -­

•	 The SF 2812-A report, if any employees were enrolled in the 

FEHB program during the reporting period; and, 

•	 A check made out to OPM in the amount shown in the Grand 

Total line under the Total column heading on the report. 

Non-Federal agencies must submit the check, the withholdings and 

contributions information on SF 2812 L, and the supporting form 

SF 2812-A to: 

Office of Personnel Management 

P.O. Box 953359 

St. Louis, MO 63195-3359 

2. "Non-check" Agencies 

Federal agencies that do not report via RITS must submit the original 

SF 2812 and the SF 2812-A to: 

Office of Personnel Management 

Funds Management Branch 

P.O. Box 582 

Washington, DC 20044 

Transmission of the withholdings and contributions should be via the 

non-check system. Payment and vouchering will be in accordance 

with instructions issued in the Treasury Fiscal Manual, Volume I, 

Part 3-3000. 

For "non-check" agencies submitting data via RITS, the report should 

be transmitted no later than the payroll paid date. A transfer of funds 

equal to the total withholdings and contributions reported will occur 

automatically on the payroll paid date via the On-Line Payment and 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
32 CSRS Payroll Office Reporting of FERS 

Withholdings and Contributions 

Chapter 80 

Collection System (OPAC). 

Information in this chapter has not been updated since August 1996 

August, 1996 CSRS and FERS Handbook 
 CSRS	 Payroll Office Reporting of FERS 33 

Withholdings and Contributions 

Chapter 80 

Subchapter 80B Job Aids 

Section 80B1.1-1 Blank Forms for Local Reproduction and Sample Completed Forms 

Blank Forms for Local Reproduction -­

•	 Report of Withholdings and Contributions for Health Benefits, Life 

Insurance and Retirement (addressed to OPM, Washington, DC), 

SF 2812 

•	 Report of Withholdings and Contributions for Health Benefits, Life 

Insurance and Retirement (addressed to OPM in St. Louis, MO), 

SF 2812 L 

•	 Report of Withholdings and Contributions for Health Benefits, 

SF 2812-A 

Sample Completed Forms -­

•	 Sample Completed SF 2812 

•	 Sample Completed SF 2812-A 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
34 CSRS Payroll Office Reporting of FERS 

Withholdings and Contributions 

Chapter 80 

Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement 

Interagency Report

No.1064-OPM-AR 

Payroll Office Number Report Number 

Month reported on Statement of

Transactions Date payroll paid 

Pay

From: 

Period 

To: 

Telephone number (including area code) G Check attached G Credit to OPM Receipt Acct.(24X8135.8) 

Agency account

charged 

OFFICE OF PERSONNEL MANAGEMENT 

ATTN: FUNDS CONTROL SECTION 

POST OFFICE BOX 582 

WASHINGTON, DC 20044 

I certify that the items listed herein are correct and the amount is available to be

credited to the OPM receipt account. 

Signature of authorized Administrative or Certifying

Officer 

Date 

Benefit Category Withholdings Contributions Total 

LIFE INSURANCE 

Basic Life 

Standard - Option A 

Additional - Option B 

Family - Option C 

Post-Retirement 

Total Life Insurance 

HEALTH BENEFITS 

Regular 

Temporary Continuation of

Coverage (PL 100-654) 

Total Health Benefits 

RETIREMENT 

CSRS 

All Categories1 

Salary Offset - Reemployed

Annuitants 

Military and Civilian Service

Credit 

FERS 

Regular 

Military Reserve Technicians 

Special2 

Salary Offset - Reemployed Annuitants 

Military Deposit 

Total Retirement 

Grand Total 

SF 2812 

Update 14 

CSRS and FERS Handbook August 15, 1995 
 CSRS Payroll Office Reporting of FERS 35 

Withholdings and Contributions 

Chapter 80 

Report of Withholdings and Contributions for Health Benefits, 

Life Insurance and Retirement 

Interagency Report

No.1064-OPM-AR 

Payroll Office Number Report Number 

Month reported on Statement

of Transactions Date payroll paid 

Pay

From: 

Period 

To: 

Telephone number (including area code) G Check attached G Credit to OPM Receipt Acct.(24X8135.8) 

Agency account

charged 

OFFICE OF PERSONNEL MANAGEMENT 

POST OFFICE BOX 953359 

ST. LOUIS, MISSOURI 63195-3359 

I certify that the items listed herein are correct and the amount is available to be

credited to the OPM receipt account. 

Signature of authorized Administrative or Certifying

Officer 

Date 

Benefit Category Withholdings Contributions Total 

LIFE INSURANCE 

Basic Life 

Standard - Option A 

Additional - Option B 

Family - Option C 

Post-Retirement 

Total Life Insurance 

HEALTH BENEFITS 

Regular 

Temporary Continuation of

Coverage (PL 100-654) 

Total Health Benefits 

RETIREMENT 

CSRS 

All Categories1 

Salary Offset - Reemployed

Annuitants 

Military and Civilian Service

Credit 

FERS 

Regular 

Military Reserve Technicians 

Special2 

Salary Offset - Reemployed Annuitants 

Military Deposit 

Total Retirement 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook April, 1998 
36 CSRS Payroll Office Reporting of FERS 

Withholdings and Contributions
 

Chapter 80
 

Grand Total 

SF 2812 L 

Information in this chapter has not been updated since August 1996 

August, 1996 CSRS and FERS Handbook 
 CSRS Payroll Office Reporting of FERS 37 

Withholdings and Contributions
 

Chapter 80
 

Blank 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook April, 1998 
38 CSRS Payroll Office Reporting of FERS 

Withholdings and Contributions 

Chapter 80 

Report of Withholdings and Contributions for Health Benefits (By Enrollment Code) 

Department or establishment Payroll Office Number Report Number 

Bureau, division or office Phone Number (Ind. Area Code) Pay Period From Pay Period To 

Address (including ZIP Code) Date Payroll Paid 

Enrollment Total Withholdings Number Enrollment Total Withholdings Number Enrollment Total Withholdings & Number 

Code No. & Contributions Enrolled* Code No. & Contributions Enrolled* Code No. Contributions Enrolled*

 *Number of Enrollees is Required on Report for Last Payroll Standard Form 2812-A

 Paid in March and September Rev. August 1988 

Information in this chapter has not been updated since August 1996 

August, 1996 CSRS and FERS Handbook 
 CSRS Payroll Office Reporting of FERS 39 

Withholdings and Contributions 

Chapter 80 

Report of Withholdings and Contributions for Health Benefits, 

Life Insurance and Retirement -- EXAMPLE 

Interagency Report

No.1064-OPM-AR 

FROM: (Address-Including Department,Bureau,Location and Zip Code) 

ABC Agency

Central Office 

Washington, DC 20001 

Payroll Office

Number 66-00-0001 Report Number90-06 

Month reported on

Statement of Transactions 3-89 

Date payroll paid

 3-20-90 

Pay From: 2-25-90 Period 

To: 3-10-90 

Telephone number (including area code)

(202) 606-1111 G Check attached Gx Credit to OPM Receipt Acct.(24X8135.8) 

Agency account

charged 66770100 

OFFICE OF PERSONNEL MANAGEMENT 

ATTN: FUNDS MANAGEMENT BRANCH 

POST OFFICE BOX 582 

WASHINGTON, DC 20044 

I certify that the items listed herein are correct and the amount is available

to be credited to the OPM receipt account. 

Signature of authorized Administrative or

Certifying Officer 

Date 

Benefit Category Withholdings Contributions Total 

LIFE INSURANCE 

Basic Life 5,938.14 2,969.06 

Standard - Option A 1,029.20 

Additional - Option B 3,445.69 

Family - Option C 450.66 

Post-Retirement 

Total Life Insurance 10,863.69 2,969.06 13,832.75 

HEALTH BENEFITS 

Regular 24,290.87 36,878.48 

Temporary Continuation of

Coverage (PL 100-654) 

293.45 (2.00) 

Total Health Benefits 24,584.32 36,876.48 61,460.80 

RETIREMENT 

CSRS 

All Categories1 72,812.91 73,335.22 

Salary Offset - Reemployed

Annuitants 

564.00 

Military and Civilian Service

Credit 

7,803.00 

FERS 

Regular 1,900.00 25,993.53 

Military Reserve Technicians 15.00 203.52 

Special2 27.70 486.00 

Salary Offset - Reemployed Annuitants 420.00 

Military Deposit 150.00 

Total Retirement 82,708.61 101,002.27 183,710.88 

Grand Total 118,156.62 140,847.81 259,004.43 

SF 2812 
40 CSRS Payroll Office Reporting of FERS 

Withholdings and Contributions
 

Chapter 80
 

Update 14 CSRS and FERS Handbook August 15, 1995
 

Information in this chapter has not been updated since August 1996 

August, 1996 CSRS and FERS Handbook 
 CSRS Payroll Office Reporting of FERS 41 

Withholdings and Contributions 

Chapter 80 

Report of Withholdings and Contributions for Health Benefits (By Enrollment Code) -- Example 

Department or establishment Payroll Office Number Report Number

 ABC Agency 66-00-0001 90-06 

Bureau, division or office Phone Number (Ind. Area Code) Pay Period From Pay Period To 

Central Office (202) 606-1111 2-25-90 3-10-90 

Address (including ZIP Code) Date Payroll Paid

Washington, DC 20001 3-20-90 

Enrollment Total Withholdings & Number Enrollment Total Withholdings Number Enrollment Total Withholdings & Number 

Code No. Contributions Enrolled* Code No. & Contributions Enrolled* Code No. Contributions Enrolled* 

101 5,185.00 85 

102 20,818.20 156 

104 11,266.20 330

105 3,722.04 49

201 2,057.28 32

202 1,198.10 10 

204 6,798.47 197

205 1,181.28 16

455 55.79 1

501 1,126.19 27

505 2,319.84 27

E51 1,499.05 35 

E54 4,233.36 124

*Number of Enrollees is Required on Report for Last Payroll Standard Form 2812-A

 Paid in March and September. Rev. August 1988 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook April, 1998