RI 92-22 Annuity Supplement Earnings Report

2021 Annuity Supplement
Earnings Report
Claim Number

OMB Approval 3206-0194
U.S. Office of Personnel Management
Retirement Surveys & Students Branch
1900 E Street, NW
Washington, DC 20415-0001
DOB

Date

Case Name

•

Complete and return this form if your allowable earnings were more than $18,960 or if your FERS
Annuity Supplement was reduced in a previous year. If you answered "No" to questions 1 and 2
below, please do not return this form.
The annuity supplement part of your FERS benefit is subject to an earnings test similar to the one applied to Social
Security Benefits and uses the same exempt amount, as required by law in 5 U.S.C. §8421a. Your annuity
supplement will be reduced $1.00 for every $2.00 by which you exceed the exempt amount ($18,960 for 2021).
By law, this reduction is effective July 1, 2022. We apply the test only to earnings you received in 2021 after
retirement and after you reach the Minimum Retirement Age (MRA). Certain reemployed Air Traffic Controllers
(ATC) are also exempt from this earnings test. The exempt amount for 2022 is $19,560.
Please answer the following questions and return this survey form no later than June 30, 2022.
1. Is your annuity supplement currently reduced because you reported excess gross work earnings in a previous
year?
Yes (Please skip directly to question 4 and report your gross work earnings for 2021.)
No (Please continue to question 2.)

2. Were your earnings more than $18,960 in 2021 after retirement? Note: See ATC exemption on the back of
the report form.
Yes (Please continue to question 3.)
No (Do Not Return This Form.)

3. Refer to the chart below to find out what you should report based on your year of birth.
Year of Birth

What You Should Report

1960 - 1964

Report all 2021 gross work earnings after retirement, if your earnings were more than $18,960.

1965

Report all 2021 gross work earnings after retirement and after you turned 56 years and 2 months,
if your earnings were more than $18,960. (If under $18,960, Do Not Return This Form.)

4. What were your gross work earnings in 2021 after
retirement? Note: See ATC exemption on the
back of the report form.
Warning:

Dollars

.

Cents

Your earnings for 2021 will be verified through a computer match with the Social Security Administration's earning file.
Any intentionally false statement or willful misrepresentation is punishable by fine, imprisonment, or both (18 U.S.C. 1001).

Signature

Daytime telephone number

Previous editions are not usable

Date (mm/dd/yyyy)

Email address

RI 92-22
Revised March 2022

Instructions:
1.

2.

Read the section below entitled: How To Determine The Amount of Earnings You Should Report. If you have questions,
please telephone 1-888-767-6738 Monday through Friday between 7:40 AM and 5:00 PM, Eastern Time. Hearing impaired
users should utilize the Federal Relay Service by dialing 711 or their local communications provider to reach a
Communications Assistant.
Provide clear and legible information. Do not detach any portion of this form.

3.

Fill in, sign, and mail this report in the envelope provided, or mail the report to: U.S. Office of Personnel Management,
Retirement Surveys and Students Branch, FERS Annuity Supplement Survey, 1900 E St., NW, Room 2416, Washington,
DC 20415-0001 or fax your response to (202) 606-0022.

4.

Retain copies of evidence supporting your claimed earnings in the event you are required to furnish documentation of
earnings.

5.

Do Not include your annuity payments from OPM or any ATC earnings as described in the next section. Include, as
earnings, all income from wages and self-employment that you actually received plus deferred income you actually earned
during 2021.

How To Determine The Amount of Earnings You Should Report
Include as earnings:
- All gross wages from employment covered by Social
Security.
- All cash pay for agricultural work, domestic work in a
private home, service not in the course of your employer's
trade or business.
- All pay, cash or non-cash, for work as a home worker for a
non-profit organization, no matter the amount. (The Social
Security $100.00 tax test does not apply.)
- All pay for work not covered by Social Security, if the
work is done in the United States, including pay for:
* Family employment,

Aviation Administration, including an instructor or
supervisor working at an on-site facility (such as an
airport). See 5 U.S.C. §8421a(c).
- Any income paid as retirement income, including
your FERS benefit or any benefits received as a survivor.
- Monies which you earned before entitlement for annuity
supplement and/or received for annual leave upon
retirement. This includes separation incentives.
- Unemployment compensation.
- Gifts, insurance proceeds, inheritances, scholarships,
alimony, capital gains, net business losses, prize winnings.
- Payments-in-kind for domestic service in the employer's
private home, for agricultural labor, for work not in the
course of the employer's trade or business, or the value of
meals and lodging.

* Work as a student, student nurse, intern,
newspaper and magazine vendor,
* Work for States or foreign governments or
instrumentalities, and
* Work covered by the Railroad Retirement Act.
Regardless of what income is called or who receives it, if it
is actually wages for services you performed or net
earnings from self-employment you secured, it must be
included in applying the earnings test.

Do not include as earnings:
- Post retirement earnings of a retired air traffic controller
who is employed as an air traffic control instructor, or
supervisor thereof, under contract with the Federal

- Rentals from real estate which cannot be counted in
earnings from self-employment because, for instance,
you were not a real estate dealer.
- Interest and dividends not resulting from trade or business.
- Pay for Veteran's training and for jury duty.
- Payments by an employer which are reimbursement
specifically for your travel expenses and which are so
identified by the employer at the time of payment and/or
reimbursement or allowance for moving expenses, if they
are not counted as wages for Social Security purposes.

For more information about the Annuity Supplement, refer to Information for FERS Annuitants, RI 90-8. Information begins in
Part B. If you would like a copy of this booklet, call the Retirement Information Office toll free at 1-888-767-6738; hearing
impaired users should utilize the Federal Relay Service by dialing 711 or their local communications provider to reach a
Communications Assistant; or write: U.S. Office of Personnel Management, Post Office Box 45, Boyers, Pennsylvania 16017.
This booklet is also available on the OPM website at www.opm.gov/retirement-services/publications-forms/pamphlets/RI90-8.pdf.
Remember your annuity supplement will stop at the end of the month you reach age 62 or the month before you become entitled
to social security benefits, whichever is earlier.
Privacy Act Statement
Pursuant to 5 U.S.C.§ 552a(e)(3), this Privacy Act Statement serves to inform you of why OPM is requesting the information on the form. Authority: OPM is
authorized to collect the information requested on this form by 5 U.S.C., Chapter 84, §8421 and 5 CFR 842.504. Purpose: OPM is requesting this information in
order to determine your eligibility to continue receiving the annuity supplement and the amount of the supplement. Routine Uses: The information on this form
may be shared externally as a "routine use" to other Federal agencies and third-parties when it is necessary to determine your eligibility. For example, OPM may
share your information with other Federal, state, or local agencies and organizations in order to determine benefits under their programs, to obtain necessary
information for an eligibility determination, or to report income for tax purposes. OPM may also share your information with law enforcement agencies if it
becomes aware of a violation or potential violation of civil or criminal law. A complete list of the routine uses can be found in the OPM/CENTRAL 1 Civil
Service Retirement and Insurance Records system of records notice, available at www.opm.gov/privacy. Consequences of Failure to Provide information:
Providing this information is voluntary; however, failure to supply accurate information may result in suspension of your annuity benefit.

Public Burden Statement
We estimate providing this information takes an average 15 minutes per response, including the time for reviewing instructions, getting the needed data, and
reviewing the requested information. Send comments regarding our estimate or any other aspect of this form, including suggestions for reducing completion time,
to the United States Office of Personnel Management, Retirement Services Publications Team, (3206-0194), Washington, DC 20415-0001. The OMB Number,
3206-0194, is currently valid. OPM may not collect this information, and you are not required to respond, unless the number is displayed.
Reverse of RI 92-22
Revised March 2022