SF 2803A_Markup Application to Make Deposit or Redeposit/Application to

Application To Pay Military Deposit
For Military Service Performed After December 31, 1956
You must be currently employed and covered under CSRS to make the military deposit. You must complete the
deposit in full before the separation on which your retirement benefit will be based.
Employee's Name

Date of Birth (mm/dd/yyyy)

Social Security Number

1. Information About Employee's Military Service
To Be Completed By Employee
Branch of Military

Agency Use Only (To Be Completed By Agency HR Office)

Period of Service

Beginning Date
(mm/dd/yyyy)

Does Alternative Deposit Calculation
Under USERRA Apply?
(Check appropriate box)

Ending Date
(mm/dd/yyyy)

Yes

No

Interest
Accrual
Date
(IAD)
(mm/dd/yyyy)

Certification: The information entered above is based on official records of
this agency and is correct.
Agency Official Signature
Date (mm/dd/yyyy)

2. Employee's Acknowledgment of Understanding of Military Service Credit and Deposit Rules
I am currently employed in a position where deductions for the Civil Service Retirement System (CSRS) are being deducted from my salary,
and I wish to pay the deposit necessary to obtain credit for my military service after 1956. I understand that I must pay the entire deposit to my
employing agency before separation for retirement. I further understand that the military deposit cannot be deemed paid at retirement if I am
eligible for and elect an alternative annuity. If I do elect the alternative annuity upon retirement, any completed military deposits made to the
Fund will be refunded to me along with any other retirement contributions or payments I made to the Fund. Once I complete the deposit in full,
I understand that it can only be refunded to me if I become eligible for a refund of my retirement contributions or retire without waiving my
military retired pay (if any).
I understand that for any given full period of military service that I have performed, if I do not complete the deposit for that full period of military
service, any payments I made that were applied to that full period of military service will be refunded to me when I retire or when I become
eligible for a refund of my retirement contributions. I also understand each of the following service credit rules and how they apply to any given
full period of military service that I have performed for which I have not completed the military deposit:

z

For each period of military service performed after 1956 :

 If the first time I worked in a position where CSRS deductions were withheld from my salary was on or after October 1, 1982, the
post-1956 military service will not be used to compute or establish title to CSRS annuity if I do not complete the deposit before I
separate for retirement.

 If the first time I worked in a position where CSRS deductions were withheld from my salary was before October 1, 1982, the
post-1956 military service will not be used to compute my annuity at age 62 (or when I retire, if I retire after age 62), if I am eligible
for Social Security benefits at that time.
Finally, I understand that payment of this deposit will not make my military service creditable if it is otherwise not creditable under CSRS.
I realize that the Office of Personnel Management (OPM) is solely responsible for adjudicating and administering civil service retirement
benefits. I understand that OPM will determine if my military service can be credited in my CSRS retirement when I apply for my retirement
benefits.

Employee's Signature

Email address

Telephone number where you can be reached
during the day

(

Date (mm/dd/yyyy)

)
Standard Form 2803A
October 2009

Information For Employee

Employee Instructions for Applying to Pay Post-1956 Military Service Deposit
z Complete sections 1-16 on the front of the SF 2803, Application to Make Deposit or Redeposit.
z Complete this form, SF 2803A, Application to Pay Military Deposit for Military Service Performed After December 31,1956.
z Include a copy of your DD 214, Report of Transfer or Discharge, or equivalent record to verify your military service. If copies of the DD
214 are not available, you should complete form SF 180, Request Pertaining to Military Records, and send it to the appropriate address
(found on the form) to verify your military service. You can obtain this form from your employing agency.

z Attach documentation of military basic pay to this application. (See below)
z Give the completed SF 2803, SF 2803A, and documentation noted above to your employing agency. Your agency will compute the
military deposit you owe and give you instructions for paying the deposit.

Employee Instructions for Completing this Form (SF 2803A)
z Complete item 1 (Information About Employee's Military Service) by providing the branch of the military in which you served (e.g. Army,
Navy, etc.) and the dates of your military service. If you have more than one period of military service, make a separate entry for each
period of military service you performed. Note, a period of military service includes consecutive periods of service where there is no
break in service. For military purposes, a 1-day break separates service into two periods. Your agency will complete the section relating
to the alternative deposit computation rules and the interest accrual date.

z Read the information in item 2 and then sign and date the form, and provide a telephone number and email address where you can
be reached during the day, at the bottom of item 2.

To Obtain Documentation of Military Basic Pay
Basic pay earnings may be documented by either of the following methods:

z Actual pay records from the military service. Your agency can tell you what military pay records are acceptable for documenting
actual military earnings.

z Estimated earnings, if you do not have official records of military earnings for the entire period of service. To obtain these estimated
earnings from the military, use RI 20-97, Request for Estimated Earnings During Military Service. You can obtain this form from your
employing agency. You must attach a copy of your DD 214 for the period of military service and any available records of pay and
promotions. If the alternative deposit calculation under USERRA applies to a period of military service, you should check with your
agency for special instructions for requesting estimated earnings if you received civilian pay (military leave, annual leave) during your
period of military service.
The following records may not be used to document earnings:

z Earnings statements from tax records. (They include allowances as well as basic pay.)
z Social Security earnings statements. (They include allowances as well as basic pay and also reflect only military basic pay earned up to
the Social Security maximum wage base for withholding.)

Information For Employing Agency
Agency Instructions: The employing agency (or organization designated by the agency to administer the personnel records of the
employee) must complete the Agency Use Only section for every application before the action is processed through payroll. The agency
must indicate if the period is subject to the special comparative deposit calculation rules specified in the Uniformed Services Employment
and Reemployment Rights Act (USERRA) of 1994, as amended, by checking the appropriate block (Yes or No) under the Does Alternative
Deposit Calculation Under USERRA Apply? column. Do not leave that column blank. And, for each period of military service listed, the
agency must provide the interest accrual date for the military deposit. Finally, an authorized agency official should sign and date the
certification section.

Reverse of Standard Form 2803A
October 2009