RI 30-9 Sep 09 Mark up

United States
Office of Personnel Management
Retirement Services Prograin
Washington, DC 20415

Fonn 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 ofbasic pay for the position yon occupied immediately before retirement, provided:
You havepot 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
Einployees 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 inust 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 yoiu full name, CSA number, date of birth, current address, and the information requested in iteins 3 - 5. If your inarital status has
changed since your annuity was terminated, your letter should state your current inarital status. Also, please provide your email address in
case OPM needs to contact you. %, ,,

.

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 governinent, state this in your letter. If you have been reeinployed 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 reeinployinent is, or was, under CSRS or FERS. If available, subinit a copy
of your latest SF 50. (Ifyou 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 inust be reduced by the amount of annuity allocable to the
period of reeinployinent 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 si~binit.Since it is your responsibility to docuinent your continuing disability, OPM will not pay for the cost of
this examination. If you fail to submit a current inedical examination report, your annuity will not be reinstated until such time as the
medical docuinentation 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. Iteins which inay be
subinitted as evidence are:
A. A copy of your federal incoine tax return, IRS Forin 1040, and a copy of your withholding statements, Forin W-2. If you subinit 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 einployer(s) showing incoine paid to you during the previous calendar year for which you are claiining incoine
below 80 percent.
C. As necessaly, a statement froin you s~~ppleinenting
or submitting for any of the iteins mentioned in A and B above. For example, if
you subinit Withholding Stateinent(s), Forin W-2, or stateinent(s) froin your employer(s), y o ~ uletter must certify that the statement(s)
represent your total incoine froin wages and self-employment or inust give such additional inforination as is needed to provide a
complete picture of your incoine from these sources during the calendar year. If you are unable to submit any of the iteins of evidence
details of your total incoine from wages and self-einployinent for
mentioned above, your letter should explain why and f~~rnish
consideration.
D. If forms W-2 and incoine tax returns are not available, you inay submit a computer printout you obtain froin any Social Security
Administration office showing your earnings (even if the amount is zero).
P~.ioreditio~isare not i~sable

(Sw Olho. Sirlc)

RI 30.9
Revlsed September 2009

,

How To Determine Amount of Income You Should Report
lnclude as Inconie - As explained below, include all incoine fro111wages and self-employment that you actually received plus defessed incoine
you actually earned in the calendar year for which you are claiming incoine below 80 percent of the current rate ofbasic pay for the position from
which you retired. Do not include inoney received before your retireinent.
Income froin wages is any gross salary or pay you received for working for soineone else (including overtime, vacation pay, bonuses,
severance pay, etc.).
Income from self-employment is any net profit you made from working or inanaging 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 incoine you earned but did not receive in the calendar year.
If you are reeinployed in the Federal service and your salary is reduced by the gross amount of your annuity, you must inclitde as incoine the *'
gross amount of your salary before the reduction.
If all or a portion of your incoine 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 elnployee expenses; gross revenue and pre-tax profit of the enterprise;
nuinber of workers elnployed (if a partnership, give the nuinber 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 yoiir individual share plus shares held by
i~nmediatef a ~ n i l y m e m b e r s ) . o rseparately
t
incoine received from independent busi~lessesand salary recefor soineone else.

Do not report as income - Any of the following items, unless they are employment related
Gifts
Incoine from Civil Service relire~nent
benefits, pensions, annuities, inilitaiy
retired pay, Social Security benefits,
and veteran's benefits
Insurance proceeds
Unelnploy~nentcompensation
Rents or royalties unless received in the
course of your trade or business

*

*

~iti~drawals
from 40 1k plans
Interest or dividends froin savings
accounts, stocks, personal loans, or
home mortgages held
Money which you earned before
retireinent
Workers' coinpensation
Ainounts received in court actions

Inheritances, tmsts, estates, or
endowments
Capital gains from sale of real or
personal property
Prizes, awards, gambling or lottely
winnings
Fellowships or scholarships
Business losses
Pay for j u ~ yduty

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 ininus 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 a n n ~ ~ iist yhigher than the 60% or 40% rate, the earned a n n ~ ~ i(1
t y% x high-3 average salary x yearslmonths of service) is
payable.
Reinstated annuities begin on the first day of the year following the calendar year in which incoine froin wages and self-e~nploymentfell below
80 percent of the current rate of basic pay for the position occupied immediately before retireinent. The survivor election inade 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 tenninated.

Warning
Applications for reinstatement are subject to verification by personal investigation and computer matching with records from other governlnent agencies. Any
intentionally false statement, willful concealment of a material fact, or use of a writing or doculnent 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 inore
than 5 years, or both. (18 U.S.C. 1001)
Privacy Act Statement
Tlic informatiall you fur~iishwill bc uscd to dctcrmi~icyourcligibility to have your allnuity rcinstatctl. This information may bc sliarcd and is subjcct to vcritication, via papcr,
clcctronic mcdia, or through tlic usc of colnputcr matching programs, with national, statc, local, or othcr charitable or social sccurity administ~xtivcagc~icicsto dctcnninc and
iss~lcbcnctits u~idcrthcir proglxms, to obtain information necessary for detcrminatioll or continuati011of bcncfils ~ ~ n dthis
c r program, or to rcport inco~ncfor tax purposcs. It
Inay also be sharcd and veriticd, as notctl abovc, with law cnforcemcllt agcncics wlic~ltlicy arc illvcstigating a violation or potclltial violation of civil or criminal law.
Solicitation of this infor~iiationis autliorizcd by 5 U.S.C. 8347(a). Provision of this inforliiation is voluntary; liowcver, failurc to supply all of tlic inforniatio~lrequested may
dclay or prcvent our deter~iii~iatio~i
of your eligibility for rci~istatelnentof your annuity.

Public Burden Statement
g t ~ n l ctor rcvlcwlng Instluctions, gctt~ngthc nccdcd data, and wrltlng to rcqucst ~clnstatcmcnt Scnd
Wc cstlnlatc thrs form takcs an dvcragc I lioul pcr rcsponsc, ~ n c l u d u ~thc
colnmcnts rcgard~ngour cstlmatc 01 any otlicr aspcct of thrs for~n,lnclud~ngsuggcst~o~is
f o ~rcduc~ngtlic tlmc ~t takcs to prcparc your rcqucst, to thc Officc of Pcrsonncl
Managcmcnt (OPM), CRIS Rablioatlohs Tcaln (3206-0138). Washr~igton,DC 20415-3430 Tlic OMB Nulnbcr, 3206-0138 IS currcntly v a l ~ d OPM may not collect this
~nfor~i~at~on,'and
you alc not r c q u ~ ~ ctod rcbpontl, unlcss t h ~ snumbcr 1s dlsplaycd
Revelbe of R l 30-9
R e v ~ s e dSeptember 2009

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