Form OPM 1523 OPM 1523 Supplemental Semiannual Headcount Report

Form Approved
OMB No. 3206-XXXX

Supplemental Semiannual Headcount Report
1. Address of Payroll Office (including department, bureau,
location and zip code)

2. Payroll Office Number

3. Report Number

4. Date Payroll Paid

5. Pay Period

6. To

From

To

7. Name of Preparer (print)

8. Telephone Number

Office of Personnel Management
ATTN: Funds Management

9. I certify that the items listed herein are correct.
Signature of authorized
Date
official

P.O. Box 582
Washington, D.C. 20044-0582

Number Enrolled
Benefit Category

Dollar Amount

Deductions Made

No Deductions Made

A. Life Insurance
1. Basic
2. Standard - Option A
3. Additional - Option B
a. To age 35
b. 35-39
c. 40-44
d. 45-49
e. 50-54
f. 55-59
g. 60 & up
4. Family - Option C
5. Post-Retirement - Basic
6. Total Life Insurance *
B. Health Benefits
1. Regular
2. Payers of Full Premiums
3. Total Health Benefits *
* Dollar amounts must agree with SF 2812 for same reporting period.

Public Burden Statement
We estimate this form takes an average of 30 minutes to complete, including the time for reviewing instructions, getting the needed data, and reviewing the completed form. Send comments
regarding our time estimate or any other aspect of this form, including suggestions for reducing completing time, to the Office of Personnel Management, Funds Management, P.O. Box 582,
Washington, DC 2044. The OMB Number 3206-XXXX is currently valid. OPM may not collect this information, and you are not required to respond, unless this number is displayed.

Office of Personnel Management

This form may be locally reproduced

CSRS/FERS Handbook for Personnel and Payroll Offices

Previous editions unusable

OPM Form 1523
Revised November 2013
Page 1

Supplemental Semiannual Headcount Report
Payroll Office Number

Report Number

Benefit Category
C. Retirement
1. CSRS

Dollar Amount
CPDF

Payroll Paid Date
Aggregate Base
Salary

Number Enrolled

Deductions Made

No Deductions Made

Code

a. Regular Withholdings

1,R

b. Regular Contributions

1,R

c. Special Withholdings

6,T

d. Special Contributions
e. Regular Withholdings
for Offset Employees
f. Regular Contributions
for Offset Employees
g. Special Withholdings
for Offset Employees
h. Special Contributions
for Offset Employees

6,T
C
C
E
E
**

i. Salary Offset

**

j. Military Deposits

**

k. Civilian Service Credit
2. FERS
a. Regular Withholdings

K

b. Regular Contributions
c. Reserve Technicians
Withholdings
d. Reserve Technicians
Contributions
e. A/T Controllers
Withholdings
f. A/T Controllers
Contributions
g. Law Enforcement/Firefighters Withholdings
h. Law Enforcement/Firefighters Contributions

K
N
N
L
L
M
M
**

i. Salary Offset
j.
k. Military Deposits

* Dollar amounts must agree with SF 2812 for same reporting period.
** Memo entry only (do not include on line 4, Total Retirement).

**

OPM 1523
Revised November 2013
Page 2

Supplemental Semiannual Headcount Report
Payroll Office Number

Report Number

Benefit Category

Dollar Amount

Payroll Paid Date
Aggregate Base
Salary

Number Enrolled

C. Retirement - Continued
3. FERS-RAE

CPDF

Deductions Made

No Deductions Made

Code

a. Regular Withholdings-RAE

KR

b. Regular Contributions-RAE
c. Reserve Technicians
Withholdings-RAE
d. Reserve Technicians
Contributions-RAE
e. A/T Controllers
Withholdings-RAE
f. A/T Controllers
Contributions-RAE
g. Law Enforcement/Firefighters Withholdings-RAE

KR
NR
NR
LR
LR
MR

h. Law Enforcement/Firefighters Contributions-RAE

MR
**

i. Salary Offset-RAE
j.
k. Military Deposits-RAE

**

4. Total Retirement*
D. Grand Total (Dollars only)
E. Total Employees (and/or Annuitants) on Payroll

* Dollar amounts must agree with SF 2812 for same reporting period.
** Memo entry only (do not include on line 4, Total Retirement).

OPM 1523
Revised November 2013
Page 3