CSRS Headcounts FERS i 

Chapter 85
 

Table of Contents 

Subchapter 85A CSRS and FERS 

Part 85A1 General Information 

Section 85A1.1-1 Overview ......................................... 1
 

A. General .................................................... 1
 

B. Topics Covered ............................................... 1
 

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

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

Section 85A1.1-2 Purpose and Background .............................. 3
 

A. Purpose .................................................... 3
 

B. Background ................................................. 3
 

Part 85A2 Requirements 

Section 85A2.1-1 Rules Governing Submission of Headcount Reports ............ 4
 

A. Reporting Periods ............................................. 4
 

B. Special Changes in SF 2812-A ..................................... 4
 

C. Completing the Header Blocks of OPM Form 1523 ........................ 4
 

D. Second Page Header Blocks for OPM Form 1523 ......................... 5
 

E. Instructions for Completing Header Blocks ............................. 5
 

F. Reporting Premiums and Deductions ................................. 6
 

Part 85A3 Headcount Reporting for Life Insurance 

Section 85A3.1-1 Line A1: Basic Life Insurance .......................... 7
 

A. General .................................................... 7
 

B. Line A1: Dollar Amount ........................................ 7
 

C. Line A1: Deductions Made ....................................... 7
 

D. Line A1: No Deductions Made ..................................... 7
 

Section 85A3.1-2 Lines A2, A3, and A4: Optional Life Insurance ............... 8
 

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

B. Lines A2, A3a through g, and A4: Dollar Amount ........................ 8
 

C. Lines A2, A3a through g, and A4: Deductions Made ...................... 8
 

D. Lines A2, A3a through g, and A4: No Deductions Made .................... 8
 

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Chapter 85
 

Section 85A3.1-3 Line A5: Post-Retirement Basic Life Insurance ............... 9
 

A. General .................................................... 9
 

B. Line A5: Dollar Amount ........................................ 9
 

C. Line A5: Deductions Made ....................................... 9
 

D. Line A5: No Deductions Made ..................................... 9
 

Section 85A3.1-4 Line A6: Total Life Insurance ......................... 10
 

A. Line A6: Total Life Insurance ..................................... 10
 

Part 85A4 Headcount Reporting for Health Benefits 

Section 85A4.1-1 Completing OPM Form 1523 for Health Benefits .............. 11
 

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

B. Purpose .................................................... 11
 

C. Cross Reference ............................................... 11
 

Section 85A4.1-2 Lines B1, B2, and B3: Health Benefits ..................... 12
 

A. Line B1: Dollar Amount ......................................... 12
 

B. Line B1: Number Enrolled ....................................... 12
 

C. Line B2: Dollar Amount ......................................... 12
 

D. Line B2: Number Enrolled ....................................... 13
 

E. Line B3: Dollar Amount ......................................... 13
 

F. Line B3: Number Enrolled ....................................... 13
 

Section 85A4.1-3 Additional Reports Due for Certain Health Benefits Enrollees ..... 14
 

A. General .................................................... 14
 

B. Cross Reference ............................................... 14
 

C. Additional Reports for Former Spouses ................................ 14
 

D. Additional Reports for Individuals Enrolled in FEHB Under the TCC Provisions ..... 15
 

E. Additional Reports for Temporary Employees ........................... 15
 

Section 85A4.1-4 Reconciling Health Benefits Enrollment Information With Carriers . . 16
 

A. General .................................................... 16
 

B. Carriers Required to Reconcile FEHB Enrollment with Federal Agencies .......... 16
 

C. Agency Responsibility ........................................... 16
 

Information in this chapter has not been updated since August 1996 

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Chapter 85
 

Part 85A5 Headcount Reporting for Retirement 

Section 85A5.1-1 General Information for Retirement Headcounts .............. 17
 

A. General .................................................... 17
 

B. Agencies Not Required to Complete the Retirement Portion of OPM Form 1523 ..... 17
 

C. Retirement Portion of OPM Form 1523 ............................... 17
 

D. Relationship to SF 2812 ......................................... 18
 

E. Aggregate Base Salary .......................................... 18
 

F. Totaling the Retirement Portion of OPM Form 1523 ....................... 18
 

Section 85A5.1-2 CSRS Portion of OPM Form 1523 ........................ 19
 

A. General .................................................... 19
 

B. Line C 1a: Regular Withholdings ................................... 19
 

C. Line C 1b: Regular Contributions ................................... 19
 

D. Line C 1c: Special Withholdings ................................... 19
 

E. Line C 1d: Special Contributions ................................... 19
 

F. Line C 1e: Regular Withholdings for CSRS Offset Employees ................ 19
 

G. Line C 1f: Regular Contributions for CSRS Offset Employees ................ 20
 

H. Line C 1g: Special Withholdings for CSRS Offset Employees ................. 20
 

I. Line C 1h: Special Contributions for CSRS Offset Employees ................ 20
 

J. Line C 1i: CSRS Salary Offset ..................................... 20
 

K. Line C 1j: CSRS Military Deposits .................................. 20
 

L. Line C 1k: CSRS Civilian Service Credit .............................. 20
 

Section 85A5.1-3 FERS Portion of OPM Form 1523 ........................ 21
 

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

B. Line C 2a: Regular Withholdings ................................... 21
 

C. Line C 2b: Regular Contributions ................................... 21
 

D. Line C 2c: Military Reserve Technician Withholdings ...................... 21
 

E. Line C 2d: Military Reserve Technician Contributions ..................... 21
 

F. Line C 2e: Air Traffic Controller Withholdings .......................... 21
 

G. Line C 2f: Air Traffic Controller Contributions .......................... 22
 

H. Line C 2g: Law Enforcement Officer/Firefighter Withholdings ................ 22
 

I. Line C 2h: Law Enforcement Officer/Firefighter Contributions ................ 22
 

J. Line C 2i: FERS Salary Offset ..................................... 22
 

K. Line C 2j: Reserved ............................................ 22
 

L. Line C 2k: FERS Military Deposits ................................. 22
 

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Chapter 85
 

Part 85A6 Totaling OPM Form 1523
 

Section 85A6.1-1 Procedure ........................................ 23
 

A. General .................................................... 23
 

B. Submitting a Completed Headcount Report to OPM ........................ 23
 

Section 85A6.1-2 Correction of Errors in Headcount Reports .................. 24
 

A. General .................................................... 24
 

B. Errors in Amounts Between SF 2812 and OPM Form 1523 ................... 24
 

C. Adjustments Requested by OPM .................................... 24
 

D. Other Errors ................................................. 24
 

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Chapter 85
 

Subchapter 85B Sample Forms 

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

SF 2812 ...................................................... 26
 

Report of Withholdings and Contributions for Health Benefits By Enrollment Code, 

SF 2812-A ................................................... 27
 

Supplemental Semiannual Headcount Report, OPM Form 1523 ................... 28
 

Report of Withholdings and Contributions for Health Benefits By Enrollment Code, 

SF 2812-A - for Former Spouses .................................... 30
 

Report of Withholdings and Contributions for Health Benefits By Enrollment Code, 

SF 2812-A - for Temporary Employees ................................ 31
 

Report of Withholdings and Contributions for Health Benefits By Enrollment Code, 

SF 2812-A - for Temporary Continuation of Coverage ...................... 32
 

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Chapter 85 

FERS 1 

Subchapter 85A CSRS and FERS 

Part 85A1 General Information 

Section 85A1.1-1 Overview 

A. General	 This Chapter describes the procedures for headcount reporting. The 

Headcount provides a "snapshot" of agency-wide enrollment in the Federal 

retirement, life insurance, and health benefits programs. 

Payroll offices should use these instructions to submit accurate and timely 

headcount reporting documents to OPM on OPM Form 1523, Supplemental 

Semiannual Headcount Report, or electronically via the Retirement and 

Insurance Transfer System (RITS). The information in this Handbook 

Chapter is designed to help agencies file headcount reports correctly 

whether transmitted electronically through RITS or by hard copy on OPM 

Form 1523. 

B. Topics Covered	 This Chapter covers: 

•	 The definitions, purpose, and background material relevant to payroll 

office headcount reporting; 

•	 The instructions for completing general portions of OPM Form 1523, 

Supplemental Semiannual Headcount Report, for life insurance, health 

benefits, and retirement; and 

•	 The instructions for submitting headcount reports to OPM. 

Information in this chapter has not been updated since August 1996 

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Chapter 85 

FERS 

C. Organization of 

Subchapter 

This subchapter has six parts. 

Part Name of Part Page 

85A1 General Information 1 

85A2 Requirements 4 

85A3 Headcount Reporting for

 Life Insurance 7 

85A4 Headcount Reporting for

 Health Benefits 11 

85A5 Headcount Reporting for

 Retirement 17 

85A6 Completing and Submitting

 Headcount Reports 23 

D. Statement of	 This Chapter is based on the laws and regulations cited below. 

Authority 

•	 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 

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Chapter 85 

Section 85A1.1-2 Purpose and Background 

A. Purpose	 Headcount reporting is done to properly account for enrollment in Federal 

employee benefit programs for purposes of financial management and 

actuarial determinations. 

All agencies must complete a headcount report semiannually, for the last 

payroll periods paid during the 1st through the 15th of March and 

September. 

B. Background	 A headcount report of the number of employees participating or enrolled in 

each type of Federal employee benefit program is made in conjunction with 

normal payroll office reports of contributions and deductions of funds to 

support retirement, health benefits, and life insurance on SF 2812, Report 

of Withholdings and Contributions for Health Benefits, Life Insurance and 

Retirement, and SF 2812-A, Report of Withholdings and Contributions for 

Health Benefits by Enrollment Code. The form used for headcount 

reporting is OPM Form 1523, Supplemental Semiannual Headcount Report. 

This Chapter provides instructions for completing the headcount report. 

See Chapter 80, Payroll Office Reporting of Withholdings and 

Contributions, for instructions on completing SF 2812 and SF 2812-A. 

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Chapter 85 

Part 85A2 Requirements 

Section 85A2.1-1 Rules Governing Submission of Headcount Reports 

A. Reporting Periods As part of the payroll report of deductions and contributions submitted for 

the last payroll period paid during the 1st through the 15th of March and 

September of each year, agencies must also submit a complete headcount 

report. The Headcount is submitted for the same payroll period as the 

report of deductions and contributions submitted to OPM on SF 2812 and 

SF 2812-A or through OPM's Retirement and Insurance Transfer System 

(RITS). (See Chapter 80, sections 80A1.1-2 and 80A2.1-1, for definitions 

and general reporting rules that apply to this Chapter.) 

If there is more than one payroll period with the same "payroll paid" date, 

then payroll offices must prepare a headcount report for each one of the 

payroll periods with the same payroll paid date (providing that these are the 

last payroll periods during the 1st through the 15th of March or 

September). Do not mix employees from different payroll periods on the 

same headcount report. 

A payroll office must report the Headcount whenever the last payroll period 

during the 1st through the 15th of March or September covers at least one 

employee or annuitant. 

B. Special Changes in 

SF 2812-A 

For the purposes of headcount reporting only, complete a supplemental 

SF 2812-A, Report of Withholdings and Contributions for Health Benefits 

by Enrollment Code, for each of the following special groups: 

• Former spouses 

• Temporary employees 

• Temporary Continuation of Coverage enrollees 

Additional information on reporting headcounts for these groups is provided 

in part 85A3 below. 

C. Completing the 

Header Blocks on 

OPM Form 1523 

The blocks in the header sections of OPM Form 1523 are self-explanatory, 

and are similar to the header blocks on SF 2812. (See Chapter 80, section 

80A2.1-2.) The blocks on the OPM Form 1523 that correspond directly to 

the SF 2812 must agree with the SF 2812 for the same reporting period. 

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Chapter 85 

Section 85A2.1-1 Rules Governing Submission of Headcount Reports (Cont.) 

D. Second Page	 The blocks for the header on the second page of the form are duplicates of 

Header Blocks for the three blocks found on the first page. These blocks must be completed 

OPM Form 1523 with exactly the same entries as in the corresponding blocks on the first 

page of the form. 

E. Instructions for	 1. Address 

Completing 

Header Blocks Enter the address of the agency making the report to OPM, including 

department, bureau, location, and zip code. 

2.	 Payroll Office Number 

Enter the payroll office number of the reporting payroll office. 

3.	 Report Number 

Enter the report number in this block. 

4.	 Telephone Number 

Enter the telephone number of a Point of Contact for the reporting 

agency. 

5.	 Date Payroll Paid 

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

format for this block's entry is: 

MM-DD-YY 

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 

6.	 Pay Period: 

(i)	 From: Enter the first day included in the pay period being 

reported through RITS or on the SF 2812. It is entered in 

the same format as the Date Payroll Paid. 

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Chapter 85
 

Section 85A2.1-1 Rules Governing Submission of Headcount Reports (Cont.)
 

E. Instructions for (ii) To: Enter the last day included in the pay period being reported 

Completing through RITS or on the SF 2812. It is entered in the same 

Header Blocks format as the Date Payroll Paid. 

(Cont.) 

7. Certification Signature of Authorized Officer 

(i)	 Sign the report. There must be an original signature by the 

authorized administrative or certifying officer from the payroll 

office submitting the headcount report. 

(ii)	 Enter the date the report is completed. This date must be on or 

before the date entered in the Date Payroll Paid block 

described in paragraph 5. above. 

8. Send all hard-copy reports on OPM Form 1523 to: 

Office of Personnel Management 

ATTN: Funds Control Branch 

Post Office Box 582 

Washington, DC 20044-0582 

FAX Number: (202) 606-1319 

Or, file electronically through RITS. 

F. Reporting Report all premiums and deductions in dollars and cents. Show zero cents 

Premiums and when reporting whole dollar amounts (for example, $2,127.00, not $2,127). 

Deductions 

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Chapter 85 

Part 85A3 Headcount Reporting for Life Insurance 

Section 85A3.1-1 Line A1: Basic Life Insurance 

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

for life insurance. Examples of completed forms for life insurance 

headcounts are in subchapter 85B. 

Report the number of employees paid during the reporting period who are 

enrolled in the basic life insurance portion of the Federal Employees' Group 

Life Insurance (FEGLI) program. 

Those organizations that have annuitants who are covered by postretirement life insurance for "post-1990" should use Line A1 to report the 

total amount of supplemental withholdings and contributions, the number of 

enrollees for whom deductions were made, and the number of enrollees for 

whom no deductions were made. 

B. Line A1: Dollar Enter the dollar amount of all withholdings and contributions for basic life 

Amount insurance from the SF 2812 for the same reporting period. 

C. Line A1: Enter the number of employees enrolled in basic life insurance for whom 

Deductions Made deductions were made during the reporting period. 

D. Line A1: No Report the number of employees enrolled in the program during the 

Deductions Made reporting period from whom no deductions were made. 

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Chapter 85 

Section 85A3.1-2 Lines A2, A3, and A4: Optional Life Insurance 

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

reports for optional life insurance. 

Employees may elect to purchase optional Federal Employees' Group Life 

Insurance. Such insurance coverage takes three forms: 

•	 Standard -- Option A 

•	 Additional -- Option B 

•	 Family -- Option C 

Employees pay the entire cost of these optional coverages. 

NOTE: Report Option B withholdings by the ages of enrolled employees. 

B. Lines A2, A3a	 Report, on the appropriate line, the total dollar amount of withholdings for 

through g, and each type of optional life insurance during the reporting period. The dollar 

A4: Dollar amounts entered for each line correspond to the total withholdings from all 

Amount employees covered by that specific insurance and paid during the reporting 

period. 

C. Lines A2, A3a Report, on the appropriate line, the number of employees who had 

through g, and withholdings made for each type of optional life insurance coverage during 

A4: Deductions the reporting period. 

Made 

Since employees must be enrolled in basic life insurance in order to 

purchase the optional life insurance(s), no one category of optional life 

insurance can exceed the amount reported for basic life. 

D. Lines A2, A3a Also report, in the appropriate column, the number of employees enrolled 

through g, and for optional life insurance coverage for whom no withholdings were made 

A4: No during the payroll reporting period. 

Deductions Made 

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Chapter 85 

Section 85A3.1-3 Line A5: Post-Retirement Basic Life Insurance 

A. General	 Employees who retire may elect to purchase coverage under the Federal 

Employees' Group Life Insurance program. 

Organizations, such as the Foreign Service or D.C. Government, that 

administer retirement plans for annuitants who are covered by the FEGLI 

program, must provide a headcount report on the normal semiannual 

reporting basis covering only post-retirement life insurance withholdings. 

Those organizations that have annuitants who are covered by postretirement life insurance for "post-1990" should use Line A1 to report the 

total amount of supplemental withholdings and contributions, the number of 

enrollees for whom deductions were made, and the number of enrollees for 

whom no deductions were made. 

B. Line A5: Dollar Report the dollar amount of the respective withholdings for post-retirement 

Amount basic FEGLI. 

C. Line A5: Report the number of individuals enrolled for post-retirement basic FEGLI 

Deductions Made for whom withholdings were made during the reporting period. 

D. Line A5: No Report the number of individuals enrolled for post-retirement FEGLI for 

Deductions Made whom no withholdings were made during the reporting period. 

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Chapter 85 

Section 85A3.1-4 Line A6: Total Life Insurance 

A. Line A6: Total Report the sum of all the dollar amounts shown for the life insurance 

Life Insurance	 categories. This sum must agree with the Total column on the Total Life 

Insurance line from the corresponding SF 2812 for the same reporting 

period. 

Information in this chapter has not been updated since August 1996 

April, 1998	 CSRS and FERS Handbook 
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Chapter 85 

Part 85A4 Headcount Reporting for Health Benefits 

Section 85A4.1-1 Completing OPM Form 1523 for Health Benefits 

A. General	 This section contains information and procedures for headcount reports for 

health benefits. Headcount procedures for health benefits are slightly 

different than the normal SF 2812 procedures for reporting withholdings 

and contributions (described in Chapter 80). 

A greater level of detail is needed in headcount reports regarding former 

spouses, temporary employees, and Temporary Continuation of Coverage 

(TCC) enrollees. A separate SF 2812-A--Report of Withholdings and 

Contributions for Health Benefits by Enrollment Code--summarizing each 

group's withholdings and contributions is required for all of the individuals 

in each of these special cases. 

Chapter 80 describes the procedures and information for completing the 

SF 2812-A for health benefits. 

B. Purpose	 The purpose of the headcount reporting of health benefits on OPM 

Form 1523 is to show the total amount of enrollments and combined 

withholdings and contributions for health benefits. Combined with the 

SF 2812 and SF 2812-A, the headcount report shows the number of 

enrollments and the amount of withholdings and contributions for each 

plan, and provides greater detail on the health benefit amounts entered onto 

the SF 2812. 

SF 2812-A is completed and submitted to OPM with SF 2812 or through 

RITS any time withholdings and contributions are made for health benefits. 

Reporting rules for the SF 2812-A follow those of the SF 2812 regarding 

payroll periods and are covered in Chapter 80. 

C. Cross Reference	 The Federal Employees Health Benefits Handbook for Personnel and 

Payroll Offices (formerly FPM Supplement 890-1) provides detailed 

information regarding the coverage and entitlement opportunities mentioned 

in this section. 

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Chapter 85 

Section 85A4.1-2 Lines B1, B2, and B3: Health Benefits 

A. Line B1: Dollar 1. Report the total dollar amount of withholdings for regular current 

Amount	 employees, both full time and part time, who are in covered positions 

(for example, those employees in career or career-conditional 

appointments) or annuitants who are enrolled in the Federal Employees 

Health Benefits (FEHB) program. 

2.	 The dollar amount shown in this column must equal the withholdings 

and contributions for all health benefit transactions during the payroll 

reporting period for regular employees and annuitants. 

3.	 Do not include any dollar amounts for (1) temporary employees; 

(2) former spouses or their dependents reenrolled in FEHB through the 

Spouse Equity Act; and (3) former employees enrolled under the 

Temporary Continuation of Coverage provision. (See paragraph C 

below.) 

B. Line B1: Number	 1. Report, on the appropriate line of the OPM Form 1523, the number of 

Enrolled	 regular employees or annuitants enrolled and covered by the payroll 

reporting period for the headcount. 

2.	 Exclude temporary employees, former spouses and former employees 

from the number of employees enrolled. 

NOTE: Since all employees (or entitled individuals) enrolled in health 

benefits are responsible for health benefit premiums whether 

they are in a pay status or not, there is no blank for health 

benefits on OPM Form 1523 under the "No Deductions Made" 

column heading. 

C. Line B2: Dollar	 1. Report the total dollar amount of withholdings for individuals who pay 

Amount	 full premiums or more, including former spouses who are enrolled in 

FEHB under the Spouse Equity Act; temporary employees serving 

under an appointment limited to 1 year or less who have completed 

1 year of current continuous employment, excluding any break in 

service of 5 days or less; and former employees, children, and former 

spouses, enrolled in FEHB through the Temporary Continuation of 

Coverage provisions. 

2.	 See section 85A4.1-2 of this Handbook for additional reporting 

instructions for these groups. 

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Chapter 85 

D. Line B2: Number 

Enrolled 

E. Line B3: Dollar 

Amount 

F.	 Line B3: Number 

Enrolled 

Report the number of individuals -- temporary employees; former spouses; 

and individuals authorized under the Temporary Continuation of Coverage 

provision -- enrolled for health benefits who pay full premiums (or more) 

and who paid those premiums during the reporting period. 

Report the total amount of withholdings and contributions for all categories 

of covered individuals. The amount entered here must equal the sum of 

lines B1 and B2, and agree with the total withholdings and contributions 

shown on the accompanying SF 2812 or RITS for the same reporting 

period. 

Report the total number of individuals enrolled for health benefits, 

including any individuals for whom no deductions were made during the 

reporting period. The number must equal the total number enrolled shown 

in lines B1 and B2. 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
14 CSRS Headcounts	 FERS 

Chapter 85 

Section 85A4.1-3 Additional Reports Due for Certain Health Benefits Enrollees 

A. General	 Agencies must submit special attachments to headcount reports for certain 

individuals entitled to FEHB benefits. This section contains information 

and procedures on the additional reporting requirements for these 

individuals affected by these programs. Several references are made to 

completing supplemental SF 2812-A reports. The preparation instructions 

for completing the SF 2812-A are provided in Chapter 80. 

The groups for which there are additional reporting requirements are: 

•	 Former spouses covered under the Civil Service Retirement Spouse 

Equity Act of 1984; 

•	 Separated employees, children, and former spouses covered by the 

Temporary Continuation of Coverage provisions of Public Law 

100-654; and 

•	 Temporary employees covered by Public Law 100-654. 

B. Cross Reference	 Individuals covered in this section are defined in Part 890 of Title 5 of the 

Code of Federal Regulations. Eligibility and specific rules regarding health 

benefits for these individuals is discussed in The Federal Employees Health 

Benefits Handbooks for Personnel and Payroll Offices (formerly FPM 

Supplement 890-1). 

C. Additional	 1. Certain former spouses of employees and annuitants are eligible to 

Reports for participate in the FEHB program under the Civil Service Retirement 

Former Spouses Spouse Equity Act of 1984. Former spouses pay the full cost of the 

selected health benefit plan. There are no government contributions for 

former spouse health benefits. 

2.	 Report the number of former spouses enrolled in FEHB under the 

spouse equity provisions for the payroll reporting period as well as the 

total amount of payments by former spouses for health benefits. These 

numbers are part of the totals entered onto line B2 of OPM Form 1523. 

(See section 85A4.1-2C and D.) 

3.	 Prepare a supplemental SF 2812-A that shows the enrollment codes and 

withholdings for only the former spouses. 

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April, 1998	 CSRS and FERS Handbook 
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Chapter 85 

D. Additional	 1. Certain separated employees, children, and former spouses are allowed 

Reports for to participate in the Federal Employee Health Benefits (FEHB) program 

Individuals under the Temporary Continuation of Coverage (TCC) provision of 

Enrolled in FEHB Public Law 100-654. This law allows separated employees and certain 

Under the TCC children and former spouses to continue FEHB coverage if they pay the 

Provisions full cost (102% percent, 2 percent more than the "full cost" charged to 

former spouses eligible under the Spouse Equity Act) of the selected 

health benefits plan. There are no government contributions for 

individuals enrolled under the TCC provisions. Specific criteria for the 

applicability of TCC are found in The Federal Employees Health 

Benefits Handbook for Personnel and Payroll Offices (formerly FPM 

Supplement 890-1). 

2.	 Report the number of TCC enrollees for the payroll reporting period as 

well as the total amount of premium payments by TCC enrollees as part 

of the totals reflected on Line B2 of OPM Form 1523. (See section 

85A4.1-2C and D.) 

3.	 Prepare a supplemental SF 2812-A that shows the enrollment codes and 

withholdings for only the TCC enrollees. Reporting rules for the 

SF 2812-A follow those of the SF 2812 regarding payroll periods and 

are covered in section 80A4.1-2B of Chapter 80, Payroll Office 

Reporting of Deductions and Contributions. 

E. Additional	 1. Certain temporary employees are allowed to participate in the FEHB 

Reports for program under the provisions of Public Law 100-654. Temporary 

Temporary employees who have completed 1 year of current continuous 

Employees employment, excluding any break in service of 5 days or less are 

permitted to enroll for FEHB coverage provided they pay both the 

employee and Government share of the health benefits premium. 

Specific criteria for the enrollment of temporary employees are found in 

The Federal Employees Health Benefits Handbook for Personnel and 

Payroll Offices (formerly FPM Supplement 890-1). 

2.	 Report the number of temporary employees enrolled for the reporting 

period as well as the total amount of premium payments by temporary 

employees as part of the totals reflected on Line B2 of OPM 

Form 1523. (See section 85A4.1-2C and D.) 

3.	 Prepare a supplemental SF 2812-A that shows the enrollment codes and 

withholdings for only the temporary employees enrolled in the FEHB 

program. (See section 85A4.1-3D3.) 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
16 CSRS Headcounts	 FERS 

Chapter 85 

Section 85A4.1-4 Reconciling Health Benefits Enrollment Information With Carriers 

A. General	 Although all premiums are paid to participating carriers by OPM, the 

FEHB program is essentially decentralized. Enrollment data is maintained 

by the more than 700 payroll and personnel offices throughout the Federal 

Government. OPM does not maintain the official enrollment records for 

active (other than OPM) employees or for annuitants of retirement systems 

other than CSRS and FERS. 

B. Carriers Required 

to Reconcile 

FEHB Enrollment 

with Federal 

Agencies 

C. Agency 

Responsibility 

A vital OPM financial control over the FEHB program is the existence of 

an active program of enrollment reconciliation between the carrier and the 

employing agency. OPM requires that all carriers participating in the 

FEHB program conduct periodic reconciliations of their enrollment records 

with those maintained by Federal agencies. Although OPM has placed the 

responsibility for initiating and performing these reconciliations on the 

carrier, agencies are expected to cooperate fully. 

Effective March 1991, and quarterly thereafter, agencies must forward to 

each carrier of a "prepaid" plan participating in the FEHB program a listing 

of all enrollees in that plan by option. The listing must support the FEHB 

enrollment totals reported on the Headcount and must be sent to the prepaid 

plans at the same time the Headcount is submitted to OPM. In this way, 

the carriers can validate their enrollment records four times each year 

against verifiable totals. 

NOTE: A "prepaid" plan is a comprehensive medical plan or health 

maintenance organization that provides or arranges for health care 

by designated plan providers. Note that this definition does not 

include "fee-for-service" plans, such as Blue Cross and Blue 

Shield. A list of the "prepaid" plans participating in the FEHB 

Program and their addresses for enrollment information is provided 

to all agencies each year during open season in a Payroll Office 

Letter. During the course of a year, OPM contacts the appropriate 

OPM Regional Office when a plan terminates and requests address 

labels to use in transmitting a memo to notify local installations in 

the terminating plan's service area. Agency headquarters are 

notified of plan terminations by means of Insurance Officer 

Information Bulletins. This ensures that the list of prepaid plans is 

kept current at all times. 

Information in this chapter has not been updated since August 1996 

April, 1998	 CSRS and FERS Handbook 
 CSRS	 Headcounts FERS 17 

Chapter 85 

Part 85A5 Headcount Reporting for Retirement 

Section 85A5.1-1 General Information for Retirement Headcounts 

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

retirement portion of OPM Form 1523. 

For both CSRS and FERS, the Headcount requires agencies to report the 

amount of withholdings and contributions for all varieties and categories of 

the retirement system's enrollees, the number of employees enrolled in each 

category, and the aggregate base salary subject to retirement system 

withholdings for all employees in each category. 

Headcount reporting for retirement uses the second page (reverse side) of 

OPM Form 1523, under Section C. The retirement portion of OPM 

Form 1523 is divided between contributions and withholdings for CSRS 

and for FERS. Retirement withholdings and contributions are reported to 

OPM only for employees who are on the payroll during the payroll 

reporting period used for the semiannual Headcount (last payroll periods 

paid during the 1st and 15th of March and September). 

B. Agencies Not	 Agencies that do not have employees covered by CSRS or FERS but are 

Required to still required to perform semiannual headcount reports for other benefit 

Complete the programs do not complete the retirement portion of OPM Form 1523. 

Retirement Individuals responsible for completing the semiannual headcount for these 

Portion of OPM agencies should consult part 85A6 below for information and procedures on 

Form 1523 completing and submitting the semiannual headcount report. 

C. Retirement	 Section C, the retirement portion of OPM Form 1523, displays columns for 

Portion of OPM dollar amounts, aggregate base salary, and the number of employees 

Form 1523 enrolled in each category of retirement. The section is divided between 

CSRS and FERS. There are several categories of retirement for each of the 

two systems that are identified by Civilian Personnel Data File (CPDF) 

codes. 

Column headings for the retirement portion are labeled: 

•	 Dollar Amount 

•	 Aggregate Base Salary 

•	 Number Enrolled: Deductions Made 

•	 Number Enrolled: No Deductions Made 

An example of the retirement portion of the OPM Form 1523 is shown in 

subchapter 85B. 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
18 CSRS Headcounts	 FERS 

Chapter 85 

D. Relationship to 

SF 2812 

E. Aggregate Base 

Salary 

F.	 Totaling the 

Retirement 

Portion of 

OPM Form 1523 

The entries made for the Dollar Amount column headings on OPM 

Form 1523 must match the appropriate line entries on the SF 2812 or RITS 

for the same payroll reporting period used in the semiannual Headcount. 

Only retirement withholdings and contributions for employees on the 

payroll during the same payroll period being reported may be entered. 

Aggregate base salary for the purpose of headcount reporting is defined as 

the total gross salary subject to retirement withholdings and paid for the 

reported payroll period for each category of retirement. 

Total the dollar amounts of contributions and withholdings for the 

retirement portion of OPM Form 1523 and enter this total on Line C3. 

This total dollar amount must match the total retirement line on the 

SF 2812 or RITS for the same reporting period. 

Although the aggregate base salary column is not totaled on OPM 

Form 1523, agencies must report the total number of employees from 

whom deductions were made as well as the number from whom no 

deductions where made during the payroll period being reported. 

Information in this chapter has not been updated since August 1996 

April, 1998	 CSRS and FERS Handbook 
 CSRS	 Headcounts FERS 19 

Chapter 85 

Section 85A5.1-2 CSRS Portion of OPM Form 1523 

A. General	 This section contains information and procedures for headcount reporting of 

retirement withholdings and contributions for employees under CSRS. Use 

OPM Form 1523 as well as SF 2812 or RITS to complete the report. 

Examples of completed forms for retirement withholdings and contributions 

are provided in subchapter 85B. 

Provide the amount of retirement withholdings and deductions for 

employees paid during the payroll reporting period used for the Headcount. 

The line entries on OPM Form 1523 must match those provided on 

SF 2812 or RITS. For instructions on completing the retirement portion of 

SF 2812, see Chapter 80, Payroll Office Reporting of Deductions and 

Contributions. 

B. Line C 1a: Report CSRS withholdings at the rate of 7 percent (CPDF Codes 1 and R). 

Regular Enter the total dollar amount of the regular withholdings, the total gross 

Withholdings salary subject to retirement withholdings and the number of employees for 

whom deductions were made as well as those for whom no deductions were 

made. 

C. Line C 1b: Enter the total dollar amount of CSRS agency contributions at the rate of 7 

Regular percent (CPDF Codes 1 and R). 

Contributions 

D. Line C 1c: Report CSRS withholdings at the rate of 7.5 percent (CPDF Codes 6 and 

Special T). Enter the total dollar amount of the regular withholdings, the total 

Withholdings gross salary subject to retirement withholdings and the number of 

employees for whom deductions were made as well as those for whom no 

deductions were made. 

E. Line C 1d: Enter the total dollar amount of CSRS agency contributions at the rate of 

Special 7.5 percent (CPDF Codes 6 and T). 

Contributions 

F. Line C 1e: Report CSRS withholdings at the rate of .8 percent or 7 percent after the 

Regular employee's basic pay exceeds the OASDI wage base for the year (CPDF 

Withholdings for Code C). Enter the total dollar amount of the regular withholdings, the 

CSRS Offset total gross salary subject to retirement withholdings and the number of 

Employees employees for whom deductions were made as well as those for whom no 

deductions were made. 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
20 CSRS Headcounts FERS 

Chapter 85 

G. Line C 1f: Enter the total dollar amount of CSRS agency contributions at the rate of 7 

Regular percent (CPDF Code C). 

Contributions for 

CSRS Offset 

Employees 

H. Line C 1g: Report CSRS withholdings at the rate of 1.3 percent or 7.5 percent after 

Special exceeding the OASDI wage base for the year (CPDF Code E). Enter the 

Withholdings for total dollar amount of the regular withholdings, the total gross salary 

CSRS Offset subject to retirement withholdings and the number of employees for whom 

Employees deductions were made as well as those for whom no deductions were made. 

I. Line C 1h: Enter the total dollar amount of CSRS agency contributions at the rate of 

Special 7.5 percent (CPDF Code E). 

Contributions for 

CSRS Offset 

Employees 

J. Line C 1i: CSRS Report amount of salary deducted and paid to OPM for reemployed CSRS 

Salary Offset annuitants as shown on the SF 2812 for the reporting period used for the 

headcount period. Complete the total dollar amount and number enrolled 

columns only. 

K. Line C 1j: CSRS Report military deposit payments for periods of CSRS creditable military 

Military Deposits service. Complete the total dollar amount and number enrolled columns 

only. 

L. Line C 1k: CSRS Report CSRS withholdings from reemployed CSRS annuitants who have 

Civilian Service elected to have current retirement withholdings from basic pay. (See 

Credit Chapter 100.) Complete total dollar amount and number enrolled columns 

only. 

Information in this chapter has not been updated since August 1996 

April, 1998 CSRS and FERS Handbook 
 CSRS Headcounts FERS 21 

Chapter 85 

Section 85A5.1-3 FERS Portion of OPM Form 1523 

A. General This section contains information and procedures for headcount reporting of 

retirement withholdings and contributions for employees under FERS. Use 

OPM Form 1523 as well as SF 2812 or RITS to complete the report. 

Examples of completed forms for retirement withholdings and contributions 

are provided in subchapter 85B. 

Provide the amount of retirement withholdings and deductions for 

employees paid during the payroll reporting period used for the Headcount. 

The line entries on OPM Form 1523 must match those provided on 

SF 2812 or RITS. For instructions on completing the retirement portion of 

SF 2812, see Chapter 80. 

B. Line C 2a: Report FERS withholdings at the rate of .8 percent (CPDF Code K). Enter 

Regular the total dollar amount of the regular withholdings, the total gross salary 

Withholdings subject to retirement withholdings and the number of employees for whom 

deductions were made as well as those for whom no deductions were made. 

C. Line C 2b: Report FERS contributions at normal cost (CPDF Code K). Enter the total 

Regular dollar amount. 

Contributions 

D. Line C 2c: Report FERS withholdings at the rate of .8 percent (CPDF Code N). Enter 

Military Reserve the total dollar amount of the regular withholdings, the total gross salary 

Technician subject to retirement withholdings and the number of employees for whom 

Withholdings deductions were made as well as those for whom no deductions were made. 

E. Line C 2d: Report FERS contributions at normal cost (CPDF Code N). Enter the total 

Military Reserve dollar amount. 

Technician 

Contributions 

F. Line C 2e: Air Report FERS withholdings at the rate of 1.3 percent (CPDF Code L). 

Traffic Controller Enter the total dollar amount of the regular withholdings, the total gross 

Withholdings salary subject to retirement withholdings and the number enrolled columns. 

Provide the number of employees for whom deductions were made as well 

as those for whom no deductions were made. 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook April, 1998 
22 CSRS Headcounts FERS 

Chapter 85 

G. Line C 2f: Air Report FERS contributions at normal cost (CPDF Code L). Enter the total 

Traffic Controller dollar amount only. 

Contributions 

H. Line C 2g: Law Report FERS withholdings at the rate of 1.3 percent (CPDF Code M). 

Enforcement Enter the total dollar amount of the regular withholdings, the total gross 

Officer/ salary subject to retirement withholdings and the number of employees for 

Firefighter whom deductions were made as well as those for whom no deductions were 

Withholdings made. 

I. Line C 2h: Law Report FERS contributions at normal cost (CPDF Code M). Enter the total 

Enforcement dollar amount only. 

Officer/ 

Firefighter 

Contributions 

J. Line C 2i: FERS Report amount of salary deducted and paid to OPM for reemployed FERS 

Salary Offset annuitants as shown on the SF 2812 for the reporting period used for the 

headcount period. Complete the total dollar amount and number enrolled 

columns only. 

K. Line C 2j: Reserved for future use. 

Reserved 

L. Line C 2k: FERS 

Military Deposits 

Report military deposit payments for periods of FERS creditable military 

service. Complete the total dollar amount and number enrolled columns 

only. 

Information in this chapter has not been updated since August 1996 

April, 1998 CSRS and FERS Handbook 
 CSRS	 Headcounts FERS 23 

Chapter 85 

Part 85A6 Totaling OPM Form 1523 

Section 85A6.1-1 Procedure 

A. General	 Add the total dollar amount of withholdings and contributions for life 

insurance, health benefits, and retirement shown on OPM Form 1523. 

Enter the combined amount in Section D (Grand Total line) under the dollar 

amount column heading. Include only withholdings and contributions for 

employees paid during the payroll period shown on the SF 2812 for the 

reporting period used for the headcount. Make sure that the dollar amounts 

shown on OPM Form 1523 agree with the amounts shown on the 

accompanying SF 2812 or RITS. 

Also report the total number of employees on the payroll for the payroll 

reporting period for the Headcount in Section E of OPM Form 1523. 

B. Submitting a	 A completed headcount report consists of the completed OPM Form 1523, 

Completed a matching SF 2812 and SF 2812-A for the same payroll reporting period, 

Headcount Report and supplemental SF 2812-A's for special group reporting (that is, former 

to OPM spouses, temporary employees, and individuals covered by TCC 

provisions). 

The headcount report must be submitted to OPM no later than the day that 

the last payroll period during the 1st through the 15th of March and 

September is paid. 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook	 April, 1998 
24 CSRS Headcounts	 FERS 

Chapter 85 

Section 85A6.1-2 Correction of Errors in Headcount Reports 

A. General This section contains information about adjusting errors that occur in 

headcount reports. In general, errors are corrected by submitting a 

corrected headcount report as soon as possible or as directed by OPM. 

B. Errors in The most common error made in headcount reporting is non-matching 

Amounts Between amounts between OPM Form 1523 and the corresponding SF 2812. All 

SF 2812 and OPM totals shown on OPM Form 1523 must agree with those shown on the 

Form 1523 SF 2812 that accompanies the headcount report. Prior to submission of the 

headcount report to OPM, agencies should check that these amounts agree. 

C. Adjustments Agencies must promptly make any adjustments requested by OPM. 

Requested by 

OPM 

D. Other Errors	 Since it is not possible to anticipate every type of error that may require 

adjustment, consult your agency retirement officer for specific instructions 

for correction of errors other than those described above. It is imperative 

that agencies carefully review all headcount reports prior to submission to 

OPM. 

Information in this chapter has not been updated since August 1996 

April, 1998	 CSRS and FERS Handbook 
 CSRS Headcounts FERS 25
 

Chapter 85
 

Subchapter 85B Sample Forms
 

This subchapter contains the following sample forms:
 

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

Retirement, SF 2812 .................................................. 26
 

Report of Withholdings and Contributions for Health Benefits By Enrollment
 

Code, SF 2812-A .................................................... 27
 

Supplemental Semiannual Headcount Report, OPM Form 1523 ........................ 28
 

Report of Withholdings and Contributions for Health Benefits By Enrollment Code, SF 2812-A ­

for Former Spouses .................................................. 30
 

Report of Withholdings and Contributions for Health Benefits By Enrollment Code, SF 2812-A ­

for Temporary Employees .............................................. 31
 

Report of Withholdings and Contributions for Health Benefits By Enrollment Code, SF 2812-A ­

for Temporary Continuation of Coverage .................................... 32
 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook April, 1998 
Headcounts 

Report of Withholdings and Contributions for Health Benefits, 

Life Insurance and Retirement 

Interagency Report

No.1064-OPM-AR 

FROM: (Address-Including Department, Bureau, 

Location, and Zip Code) 

ABC Agency 

Central Office 

Washington, DC 20415 

Payroll Office Number

 66-00-0001 

Report Number

 93-19 

Month reported on Statement 

of Transactions 9/93 

Date payroll paid

 9-14-93 

Pay 

From 8-22-93 

Period 

To 9-4-93 

Telephone number (including area code) 

(202)606-0679 

- Check attached x­ Credit to OPM 

Receipt 

Acct.(24X8135.8) 

Agency account 

charged 

66770100 

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 9-14-93 

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 61,742.74 72,906.90 

Temporary Continuation of Coverage

(PL 100-654) 413.95 961.86 

Total Health Benefits 62,156.69 73,868.76 136,025.45 

RETIREMENT 

CSRS 

All Categories1 71,883.70 74,525.19 

Salary Offset - Reemployed

Annuitants 564.00 

Military and Civilian Service Credit 2,567.21 

FERS 

Regular 1,900.00 30,637.50 

Military Reserve Technicians 15.00 234.38 

Special2 27.70 557.22 

Salary Offset - Reemployed

Annuitants

 420.00 

Military Deposit 150.00 

Total Retirement 76,543.61 106,938.29 + 183,481.90 

Grand Total 149,563.99 183,776.11 = 333,340.10 

1

 Employees with CPDF Retirement Codes of 1, 6, C, E, R or T. Standard Form 2812 2

 Employees with CPDF Retirement Codes of L or M. Rev. January 1990 

April 1998 CSRS and FERS Handbook 
 CSRS Headcounts FERS 27 

Chapter 85 

Report of Withholdings and Contributions for Health Benefits By Enrollment CodeInteragency Report 1064-OPM-AR 

Department or establishment 

ABC Agency 

Payroll Office 

number

 66-00-0001 

Report number

 93-19 

Bureau, division or office 

Central Office 

Pay period from

 8-22-93 

Pay period to

 9-4-93 

Address (including ZIP Code) 

Washington, DC 20001 

Date payroll paid

 9-14-93 

Agency telephone number (including area 

code)

 (202)606-0679 

Enrollmen 

t Code No. 

Total 

Withholdings & 

Contributions 

Number 

Enrolled* 

Enrollmen 

t Code No. 

Total 

Withholdings & 

Contributions 

Number 

Enrolled* 

Enrollmen 

t Code No. 

Total Withholdings 

& Contributions 

Number 

Enrolled* 

101 12,161,80 85

102 46,731.60 156

104 27,667.20 330 

105 8,107.34 49 

451 2,332.16 32 

452 1,624.60 10

454 10,766.05 197

471 1,458.88 16 

501 2,632.77 27 

505 4,143.69 2736

E51 3,402.72 124 

E55 14,996.64 

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

 Paid in March and September Rev. August 1988 

Supplemental Semiannual Headcount Report 

Information in this chapter has not been updated since August 1996 

CSRS and FERS Handbook April, 1998 
28 CSRS Headcounts FERS 

Chapter 85 

1. Address (including Department, Bureau, Location, and ZIP Code) 

ABC Agency 

Central Office 

Washington, DC 20415 

2. Payroll Office Number 

66-00-0001 

3. Report Number 

93-19 

4. Telephone Number 

(202)606-0679 

5. Date Payroll Paid 

9-14-93 

6. Pay Period 

From To 

8-22-93 * 9-4-93 

To: Office of Personnel Management 

ATTN: Funds Control Branch 

Post Office Box 582 

Washington, DC 20044-0582 

8. I certify that the items listed herein are correct. 

Signature of Authorized Officer 

Date 

Number Enrolled 

Benefit Category Dollar Amount Deductions Made No Deductions Made 

A. Life Insurance 

1. Basic 8,907.20 2,113 15 

2. Standard - Option A 1,029.20 515 4 

3. Additional - Option B 

a. To Age 35 1,025.75 922 1 

b. 35-39 627.91 605 2 

c. 40-44 611.51 421 1 

d. 45-49 311.05 75 0 

e. 50-54 506.25 26 3 

f. 55-59 327.95 5 1 

g. 60 & Up 35.27 3 0 

4. Family - Option C 450.66 527 5 

5. Post-Retirement ­

Basic 

6. Total Life Insurance* 13,832.75 

B. Health Benefits 

1. Regular 134,860.41 1079 

2. Payers of Full 

Premiums 

1,165.04 10 

3. Total Health Benefits*136,025.45 1089 

Previous editions unusable OPM Form 1523 

Office of Personnel Management Rev. September 1989 

Information in this chapter has not been updated since August 1996 

April, 1998 CSRS and FERS Handbook 
 CSRS Headcounts FERS 29 

Chapter 85 

Sample OPM Form 1523 (Cont.)Supplemental Semiannual Headcount (Cont.) 

Payroll Office Number 

66-00-0001 

Report Number 

93-19 

Payroll Paid Date 

9-14-93 

Benefit Category Dollar 

Amount 

Aggregate 

Base Salary 

Number Enrolled 

C. Retirement 

1. CSRS CPDF 

Code 

Deductions 

Made 

No 

Deductions 

Made 

a. Regular Withholdings 1,R 65,321.90 933,170.00 1805 15 

b. Regular Contributions 1,R 65,321.90 

c. Special Withholdings 6,T 6,173.55 82,314.00 217 5 

d. Special Contributions 6,T 6,173.55 

e. Regular Withholdings for 

Offset Employees 

C 265.00 33,125.00 21 1 

f. Regular Contributions for 

Offset Employees 

C 2,318.74 

g. Special Withholdings for 

Offset Employees 

E 123.25 9,480.00 10 1 

h. Special Contributions for 

Offset Employees 

E 711.00 

i. Salary Offset 564.00 2 

j. Military Deposits 1,722.21 3 

k. Civilian Service Credit 845.00 5 

2. FERS 

a. Regular Withholdings K 1,900.00 

237,500.00

 502 51 

b. Regular Contributions K 30,637.50 

c. Reserve Technicians 

Withholdings 

N 15.00 1,875.00 15 2 

d. Reserve Technicians 

Contributions 

N 234.38 

e. A/T Controllers 

Withholdings 

L 13.30 1,023.00 2 0 

f. A/T Controllers 

Contributions 

L 254.73 

g. Law Enforcement/Firefighters Withholdings M 14.40 1,108.00 2 1 

h. Law Enforcement/Firefighters Contributions M 302.49 

i. Salary Offset 420.00 1 

j. 

k. Military Deposit 150.00 2 

3. Total Retirement* 183,481.90 2,584 79 

D. Grand Total (Dollars Only) 333,340.10 
30 CSRS Headcounts FERS 

Chapter 85 

E. Total employees (and/or Annuitants) on Payroll 2,690 

* Dollar amount MUST agree with SF 2812 for same reporting period Revised OPM Form 1523 

Revised September 1989 CSRS and FERS Handbook August, 1996 

Information in this chapter has not been updated since August 1996 

April, 1998 CSRS and FERS Handbook 
 CSRS Headcounts FERS 31 

Chapter 85 

Report of Withholdings and Contributions for Health Benefits By Enrollment Code 

Department or establishment 

ABC Agency 

Payroll Office number

 66-00-0001 

Report number

 93-19 

Bureau, division or office 

Central Office 

Pay period from

 8-22-93 

Pay period to

 9-4-93 

Address (including ZIP Code) 

Washington, DC 20001 

Date payroll paid

 9-14-93 

Agency telephone number (including area code)

 (202)606-0679 

Enrollment 

Code No. 

Total Withholdings 

& Contributions 

Number 

Enrolled* 

Enrollment 

Code No. 

Total Withholdings 

& Contributions 

Number 

Enrolled* 

Enrollment 

Code No. 

Total Withholdings & 

Contributions 

Number 

Enrolled* 

454 

E51 

203.25

 83.58 

3 

1

 *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 
32 CSRS Headcounts FERS 

Chapter 85 

Report of Withholdings and Contributions for Health Benefits By Enrollment Code 

Department or establishment 

ABC Agency 

Payroll Office number

 66-00-0001 

Report number

 93-19 

Bureau, division or office 

Central Office 

Pay period from

 8-22-93 

Pay period to

 9-4-93 

Address (including ZIP Code) 

Washington, DC 20001 

Date payroll paid

 9-14-93 

Agency telephone number (including area code)

 (202)606-0679 

Enrollment 

Code No. 

Total Withholdings 

& Contributions 

Number 

Enrolled* 

Enrollment 

Code No. 

Total Withholdings 

& Contributions 

Number 

Enrolled* 

Enrollment 

Code No. 

Total Withholdings & 

Contributions 

Number 

Enrolled* 

102 325.73 1

 *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 

April, 1998 CSRS and FERS Handbook
 CSRS Headcounts FERS 33 

Chapter 85 

Report of Withholdings and Contributions for Health Benefits By Enrollment Code 

Department or establishment 

ABC Agency 

Payroll Office number

 66-00-0001 

Report number

 93-19 

Bureau, division or office 

Central Office 

Pay period from

 8-22-93 

Pay period to

 9-4-93 

Address (including ZIP Code) 

Washington, DC 20001 

Date payroll paid

 9-14-93 

Agency telephone number (including area code)

 (202)606-0679 

Enrollment 

Code No. 

Total Withholdings 

& Contributions 

Number 

Enrolled* 

Enrollment 

Code No. 

Total Withholdings 

& Contributions 

Number 

Enrolled* 

Enrollment 

Code No. 

Total Withholdings & 

Contributions 

Number 

Enrolled* 

101 

105 

226.67 

325.81 

2 

3

 *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