RI30-009_2026_07

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OMB Approved 3206-0138

United States
Office of Personnel Management
Retirement Operations
Washington, DC 20415

Reinstatement of Disability Annuity Request Form
■

Use this form to request reinstatement of a disability annuity previously terminated due to restoration to earning capacity.

■

You must meet the following 3 requirements: (1) You have not recovered medically from the disability for which you retired.
(2) 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). (3) You have not reached age 62 (or did not reach age 62 on December 31st of the year when
your income fell below the 80 percent point).

■

Your written request must be received after January 1st of the year following the year your income fell below 80 percent. Mail completed
request to: OPM, Retirement Surveys and Students, 1900 E Street NW, Washington, DC 20415.

A. Applicant Information
1. Name (Last, first, middle)

2. CSA number

3. Date of birth (mm/dd/yyyy)

4. Marital status

5. Mailing address

6. Email address

B. Reemployment Status
1. Reemployed in Federal Service
Yes
3. Agency name and address

2. Reemployed under
No

CSRS
4. Dates of reemployment (mm/yyyy)
From:
5. Position title

FERS
To:

6. Email address

C. Attached Documentation (Note: Medical Report is Required)
1. Medical report documenting disability
Yes
3. Employer statements

2. IRS Form 1040 (U.S. Individual Income Tax Return)
No

Yes
No
5. Standard Form 50 (Notification of Personnel Action)
Yes
7. Additional explanation (if needed)

No

Yes
4. IRS Form W-2 (Wage and Tax Statement)

No

Yes
6. Social Security Administration Printout

No

Yes

No

D. 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)
E. Certification
Signature

Previous editions are not usable

Date (mm/dd/yyyy)

(See Instructions on the Reverse Side)

RI 30-9
Revised July 2026

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
■ Gifts

■ Withdrawals from 401k plans

■ Inheritances, trusts, estates, or endowments

■ Income from Civil Service retirement benefits,

■ Interest or dividends from savings accounts,

■ Capital gains from sale of real or personal

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

stocks, personal loans, or home mortgages
held

■ Money which you earned before retirement
■ Workers’ compensation

property

■ Prizes, awards, gambling or lottery winnings
■ Fellowships or scholarships
■ Business losses

■ Amounts received in court actions

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.
Privacy Act Statement
Authority: OPM is authorized to collect this information under 5 U.S.C. Chapter 83, Sections 8337 & 8347(a) and Chapter 84, Section 8455. Purpose: OPM uses this information
to determine whether you are eligible to have your disability annuity reinstated. Routine Uses: The information may be shared externally as a "routine use" to other Federal
agencies and third-parties when it is necessary to process your election. For example, OPM may share your information with other Federal, state, or local agencies and
organizations to determine benefits under their programs, to obtain information necessary for a determination of your eligibility for a reinstatement of your annuity or to report
income for tax purposes. OPM may also share your information with law enforcement agencies 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 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 to OPM is voluntary. However, if you do not provide the requested information, OPM may be
unable to determine whether you are eligible to have your disability annuity reinstated.

Public Burden Statement
The public reporting burden to complete this information collection is estimated at 60 minutes per response, including time to review the instructions, search data sources,
gather and maintain the data needed, and complete and review the collected information. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection
information, including suggestions for reducing this burden to the Office of Personnel Management, RS Publications Team at [email protected]. Current
information regarding this collection of information - including all background materials - can be found at https:/www.reginfo.gov/public/do/PRAMain by using the search
function to enter either the title of the collection or OMB Control Number 3206-0138.
Reverse of RI 30-9
Revised July 2026