Reinstatement of Disability Annuity Previously Terminated Because of Restoration to Earning Capacity

United States
Office of Personnel Management
Retirement Services Program

Washington, DC 20415

Form Approved:
OMB No. 3206-0138

Reinstatement of Disability Annuity Previously Terminated Because of
Restoration to Earning Capacity
If your disability annuity was terminated because you were restored to earning capacity, the following information applies to you. You may
have your disability annuity reinstated effective the first of the year following any calendar year in which your income from wages and
self-employment fell below 80 percent of the current rate of basic pay for the position you occupied immediately before retirement, provided:
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You have not recovered medically from the disability for which you retired.
You have not been employed in the Federal service in a position under the Civil Service Retirement System (CSRS) or the Federal
Employees Retirement System (FERS).
You have not reached age 62 (or had not reached age 62 on December 31st of the year in which your income fell below the 80
percent point).

How To Apply For Reinstatement of Disability Annuity
1. You must wait until after January 1st of the year following the year in which your earnings fall below the 80 percent limitation.
2. No special form is needed to apply for reinstatement of disability annuity. Apply by sending your written, signed request to the
Office of Personnel Management, Retirement Surveys and Students Branch, 1900 E Street, NW, Washington, DC 20415-3562. Be sure
to give your full name, CSA number, date of birth, current address, and the information requested in items 3 - 5. If your marital status has
changed since your annuity was terminated, your letter should state your current marital status.
3. Your letter must clearly show whether you have been reemployed in the Federal service since you were found restored to earning
capacity. If you have not been reemployed by the Federal government, state this in your letter. If you have been reemployed in the
Federal service, you must furnish the exact name and address of your employing agency, dates of reemployment, and the title of your
position. In addition, you must specifically state whether the reemployment is, or was, under CSRS or FERS. If available, submit a copy
of your latest SF 50. (If you are reemployed by the Federal government but are not subject to CSRS or FERS deductions, you are eligible
to apply for reinstatement of your disability retirement; however, your salary must be reduced by the amount of annuity allocable to the
period of reemployment in order to avoid dual compensation.)
4. Attach to your letter a report of a current medical examination describing in detail the nature and extent of your disability.
Before a decision may be reached concerning reinstatement of disability annuity due to loss of earning capacity, it will be necessary to
establish that you still have the disability for which you originally retired. The decision as to your continuing disability will be based on
the medical evidence you submit. Since it is your responsibility to document your continuing disability, OPM will not pay for the cost of
this examination. If you fail to submit a current medical examination report, your annuity will not be reinstated until such time as the
medical documentation supporting your continued disability is received.
5. Attach to your letter evidence showing your total income from wages and self-employment in the calendar year for which you are
claiming income below 80 percent of the current rate of basic pay for the position from which you retired. Items which may be
submitted as evidence are:
A. A copy of your federal income tax return, IRS Form 1040, and a copy of your withholding statements, Form W-2. If you submit a
copy of a joint tax return, you should provide a breakdown of the earnings shown so we know how much you earned.
B. Statement(s) from your employer(s) showing income paid to you during the previous calendar year for which you are claiming income
below 80 percent.
C. As necessary, a statement from you supplementing or submitting for any of the items mentioned in A and B above. For example, if
you submit Withholding Statement(s), Form W-2, or statement(s) from your employer(s), your letter must certify that the statement(s)
represent your total income from wages and self-employment or must give such additional information as is needed to provide a
complete picture of your income from these sources during the calendar year. If you are unable to submit any of the items of evidence
mentioned above, your letter should explain why and furnish details of your total income from wages and self-employment for
consideration.
D. If forms W-2 and income tax returns are not available, you may submit a computer printout you obtain from any Social Security
Administration office showing your earnings (even if the amount is zero).

Prior editions are not usable

(See Other Side)

RI 30-9
Revised August 2005

How To Determine Amount of Income You Should Report
Include as Income - As explained below, include all income from wages and self-employment that you actually received plus deferred income
you actually earned in the calendar year for which you are claiming income below 80 percent of the current rate of basic pay for the position from
which you retired. Do not include money received before your retirement.
• Income from wages is any gross salary or pay you received for working for someone else (including overtime, vacation pay, bonuses,
severance pay, etc.).
• Income from self-employment is any net profit you made from working or managing your own business, whether at home or elsewhere. Net
profit is the amount remaining after deduction of business expenses as allowed by the Internal Revenue Service and before the deduction of
any personal expenses or benefits from the business to you.
• Deferred income is any income you earned but did not receive in the calendar year.
• If you are reemployed in the Federal service and your salary is reduced by the gross amount of your annuity, you must include as income the
gross amount of your salary before the reduction.
If all or a portion of your income was derived from a partnership, corporation, or sole proprietorship, please enclose a detailed explanation including
the following items: income you received directly from wages, fringe benefits, and employee expenses; gross revenue and pre-tax profit of the enterprise;
number of workers employed (if a partnership, give the number of partners); your role or position and hours worked; the principal product produced or
service supplied; and your total cash investment and percentage of ownership in the enterprise (include your individual share plus shares held by
immediate family members). Report separately income received from independent businesses and salary received for working for someone else.

Do not report as income - Any of the following items, unless they are employment related
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Gifts
Income from Civil Service retirement
benefits, pensions, annuities, military
retired pay, Social Security benefits,
and veteran’s benefits
Insurance proceeds
Unemployment compensation
Rents or royalties unless received in the
course of your trade or business

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Withdrawals from 401k plans
Interest or dividends from savings
accounts, stocks, personal loans, or
home mortgages held

Money which you earned before
retirement
Workers’ compensation
Amounts received in court actions

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Inheritances, trusts, estates, or
endowments

Capital gains from sale of real or

personal property
Prizes, awards, gambling or lottery
winnings
Fellowships or scholarships
Business losses
Pay for jury duty

Information About Reinstated Annuity
A CSRS annuity is reinstated at the same monthly rate the individual was receiving when the disability annuity ended. A FERS annuity is
reinstated at 60% of the average salary minus 100% of any Social Security benefit payable and is adjusted after one year to 40% of the average
salary minus 60% of any Social Security benefit payable. However, if the individual is eligible for an immediate, earned annuity based on age
and service or the earned annuity is higher than the 60% or 40% rate, the earned annuity (1% x high-3 average salary x years/months of service) is
payable.
Reinstated annuities begin on the first day of the year following the calendar year in which income from wages and self-employment fell below
80 percent of the current rate of basic pay for the position occupied immediately before retirement. The survivor election made when the
individual retired for disability will apply to the reinstated annuity if the marital status is the same. The reinstated annuity does not include any
increase granted during the period when disability annuity was not payable. A reinstated disability annuitant can be re-enrolled in health benefits
and life insurance coverage if enrollment in these programs was in effect on the date the annuity was terminated.

Warning
Applications for reinstatement are subject to verification by personal investigation and computer matching with records from other government agencies. Any

intentionally false statement, willful concealment of a material fact, or use of a writing or document knowing the same to contain a false,
fictitious, or fraudulent statement or entry, is a violation of the law punishable by a fine of not more than $10,000 or imprisonment of not more
than 5 years, or both. (18 U.S.C. 1001)
Privacy Act Statement
The information you furnish will be used to determine your eligibility to have your annuity reinstated. This information may be shared and is subject to verification, via paper,
electronic media, or through the use of computer matching programs, with national, state, local, or other charitable or social security administrative agencies to determine and
issue benefits under their programs, to obtain information necessary for determination or continuation of benefits under this program, or to report income for tax purposes. It
may also be shared and verified, as noted above, with law enforcement agencies when they are investigating a violation or potential violation of civil or criminal law.
Solicitation of this information is authorized by 5 U.S.C. 8347(a). Provision of this information is voluntary; however, failure to supply all of the information requested may
delay or prevent our determination of your eligibility for reinstatement of your annuity.
Public Burden Statement
We think this form takes an average 1 hour per response, including the time for reviewing instructions, getting the needed data, and writing to request reinstatement. Send
comments regarding our estimate or any other aspect of this form, including suggestions for reducing the time it takes to prepare your request, to the Office of Personnel
Management (OPM), OPM Forms Officer (3206-0138), Washington, DC 20415-7900. The OMB Number, 3206-0138 is currently valid. OPM may not collect this
information, and you are not required to respond, unless this number is displayed.

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Reverse of RI 30-9
Revised August 2005