RI 38-134

This form may be locally reproduced April 2002

(Instructions on the reverse)

Instructions: The Human Resources Office will complete Part 1 of this form and give it to the employee. The employee must indicate

his/her election by signing in Part 3 and returning the signed form to the Human Resources Office on or before the due date shown in 

Part 1.

Election to Retain NonAppropriated Fund (NAF) Retirement Coverage

As a Result Of A Move From A NonAppropriated Fund Position To A

Civil Service Position On or After December 28, 2001

Part 2 - Acknowledgement of Receipt and Notice of Effect of Failure to Elect

I understand that I am eligible to retain retirement coverage in the NAF retirement plan shown above. I acknowledge that the Human

Resources Office has completed Part 1 of this election form and given it to me on this date. I understand that if I fail to complete Part 3

and return the completed form to the Human Resources Office before the close of business on the Due Date (shown in Part 1) I will

automatically be considered to have chosen Option 2 in Part 3. I also understand that the option I choose below (or am automatically

considered to have chosen) will restrict my retirement plan entitlement for the rest of my Government career and that I can never change

this election regarding retention of NAF retirement coverage as a civil service employee.

Employee's Signature Date (mm/dd/yyyy)

Part 1 - (To be completed by agency)

I verify that in accordance with §§ 8347(q) and 8461(n) of title 5, U.S.C., and OPM regulations at 5 CFR part 847, this employee is eligible to

retain coverage in the NAF retirement plan because he/she —

Employee's name (last, first, middle) Date of birth (mm/dd/yyyy) Social Security Number

Name of NAF Retirement Plan Due date (mm/dd/yyyy)

Human Resources Office must receive election on or before

(1) Has never previously had an opportunity to elect to retain coverage in a NAF retirement plan; and

(2) Has moved, on or after December 28, 2001, from a NAF position subject to a NAF retirement plan to a civil service appointment

covered by CSRS, CSRS Offset, or FERS without a break of more than 1 year.

Date of move (mm/dd/yyyy)

Date signed (mm/dd/yyyy)

Authorized Signature

Title 

Part 3 - Employee's Election (Instructions to employee: Sign only the box for the option that 

 you elect.)

Option 1: I elect to retain retirement coverage in the NAF retirement plan. I understand that because of this irrevocable decision, I will

never be able to earn additional credit under the Civil Service Retirement System (CSRS) or the Federal Employees Retirement System

(FERS). I understand that regardless of future moves between NAF and civil service employment, breaks in service, and changes in

employment or retirement status, my retirement coverage will remain with a NAF retirement plan in accordance with the rules of that plan.

Employee's signature Date (mm/dd/yyyy)

Option 2: I do not elect to retain retirement coverage in the NAF retirement plan. Because I have made this decision:

(1) I will enter FERS, CSRS, or CSRS Offset coverage as appropriate. In the future, I may be able to elect to credit my NAF service to

qualify for an immediate FERS, CSRS, or CSRS Offset retirement. I will only be able to make such an election at the time I retire. I

understand that my NAF service will not increase the amount of any future FERS, CSRS, or CSRS Offset annuity to which I may

become entitled.

(2) I will not be given another opportunity to retain coverage in a NAF retirement plan if I ever move from a NAF position to a civil service

appointment in the future. However, if I move back to a NAF position, I will be subject to the NAF plan in accordance with its rules.

(3) If in the future I move back to a NAF retirement covered position without a break in service of more than 1 year, including

employment covered by the NAF retirement plan that I am leaving, I will be given a one-time opportunity (if I never before have been

given the opportunity) to elect to retain coverage in FERS, CSRS, or CSRS Offset as appropriate, or to enter the appropriate NAF

plan without transfer of FERS, CSRS, or CSRS Offset service credit.

Employee's signature Date (mm/dd/yyyy)
Reverse of RI 38-134

April 2002

Instructions for Completing Election Form RI 38-134

Election to Retain NonAppropriated Fund (NAF) Retirement Coverage As a Result Of A

Move From A NonAppropriated Fund Position To A Civil Service Position

On or After December 28, 2001

The Human Resources Office should:

(1) Complete Part 1 of the form and photocopy it. The due date is 30 days after the date of appointment. (This time limit may be waived

by the agency for employees who, despite due diligence, are prevented by circumstances beyond their control from making an

election within the time limit.)

(2) Give the original and the photocopy to the employee. Instruct the employee to read and acknowledge receiving the form by signing

Part 2 of one copy of the form.

(3) Collect the copy of the form the employee signed (with Parts 1 and 2 completed), and file it on the left side of the Official Personnel

Folder (OPF), or in some other temporary file. Keep it there until the employee makes an election, or the time limit for making the

election expires.

(4) If the employee makes an election by signing either Option 1 or Option 2 in Part 3, mark the date you received the form. Make two

photocopies of the form. File the form with the original signature in Part 3 on the right hand side of the OPF. Return one copy to the

employee. Mail the other copy to the appropriate NAF benefits office. Destroy the copy of the form with Part 2 completed.

(5) If the employee elects to retain coverage in the NAF plan, place the Notice of NAF Election flag on the right side of the OPF. This

flag will serve to alert subsequent employing offices that the employee is covered by a NAF plan and is excluded from CSRS, CSRS

Offset, or FERS.

If the employee fails to return the election form before the time limit expires, note on the form with Part 2 completed that the

employee did not file a form with Part 3 completed, and file it on the right hand side of the OPF.

The Employee should:

(1) Acknowledge receiving the form by signing Part 2 of one copy and returning it to the Human Resources Office.

(2) Keep a copy of the form with only Part 1 completed.

(3) Make a retirement coverage election by signing Option 1 or Option 2 in Part 3 of the form. Submit the election to the Human

Resources Office by the Due Date shown in Part 1. If you fail to submit an election by the due date, you will be considered to have

elected Option 2 in Part 3.