Notification to OPM of Reemployment of Annuitant

OPM requires the below information to determine continued eligibility for annuity. The agency must 

complete and send this form, along with a copy of the SF 50 to our email address at: 

ReemployedAnnuitant@opm.gov

1. Retirement Claim Number: _________________________

2. Name of Annuitant: __________________________________________________

3. Date of Birth: ________________________4. SSN: _________________________

Appointment 

5. Type of Appointment: _________________________

6. Date of Appointment (Month, Day, Year): _________________________

7. Presidential Appointment? ______Yes ________No

8. Dual Comp Waiver (including FEPCA and Public Laws 103-336,108-136, 108-447 and 108-458) in

effect? ________Yes _______No

If “No”, indicate Retirement System: CSRS/CSRS Offset FERS FICA

9. Was this appointment granted to provide interim relief pending further judicial or administrative review

of an agency adverse action, under the provisions of 5CFR 772.102?

____Yes ____No

Insurance

10. Does appointment allow FEGLI coverage? ________Yes ________No

11. If so, did annuitant make new elections? No (if no, go to Item 11) _________ Yes________ ( if yes,

please enclose copy of new elections)

12. If annuitant did not complete a new election, agency should pick-up all FEGLI carried into retirement

as of reemployment date except for Option B. What deductions for life insurance does annuitant have

under reemployment?

None________ Basic__________Option A_____________Option C___________ 

Option B__________ (note: annuitant can elect to keep Option B under employment, otherwise it is 

withheld from annuity) 

Did annuitant elect Option B withhold from employing agency? _______Yes ________No 

If “Yes,” Effective date: _________________________ 

13. Does appointment allow FEHB coverage? _______Yes ________No

If “Yes,” Effective date: _________________________ FEHB Enrollment Code: _____________
Please Note: The annuitant’s SF-2809 - Health Benefits Election Form may be submitted as prove of 

enrollment. 

14. Did annuitant elect to waive Premium Conversion? _______Yes ________No

 If “Yes,” Effective date: _________________________ 

If subject is a disability annuitant, complete the items 15-18: 

15. Position Description: ___________________________________________________

16. Pay System/Grade: ____________________________________________________

17. Salary: ________________

18. Part Time Tour of Duty (if applicable): _________________

Department of Defense Agencies Only 

Public Law 108-136 implemented a blanket dual compensation waiver for annuitants reemployed at a DoD agency.

This means that the reemployment provisions in title 5 do not apply to these annuitants. They will not be subject to 

salary offset (or to an administrative recovery finding if a disability retirement). Nor will they be eligible for an 

additional benefit based on the reemployment service. This waiver applies to all types of retirement except for an 

Involuntary Retirement. A subsequent law (P.L. 110-181) provided an opportunity for annuitants retired under an

involuntary retirement who reemploy with DoD to elect to waive the provisions of the dual compensation 

legislation and be subject to coverage as a reemployed annuitant. The legislation provides that an election for 

coverage must be filed not later than the latter of 90 days after the date the Department of Defense: (i) prescribes 

regulations to carry out this subsection; or (ii) takes reasonable actions to notify employees who may file an 

election. If an employee files an election under this paragraph, coverage will be effective beginning on the first day 

of the first applicable pay period beginning on or after the date of the filing of the election. If an annuitant whose 

retirement was involuntary waives the dual compensation waiver and opts to become a reemployed annuitant under 

title 5, agencies must provide OPM with a copy of the annuitant waiver of the dual compensation waiver. 

Agency Certification: I certify that the information provided above is correct.

_________________________ ________________ 

Agency Representative Name Date

_________________________ ________________ 

Position Title

__________________________ 

Signature 

_________________________ 

Contact Number FAX Number

_________________________ 

Email Address

Agency Name and Address: