Request for Retirement Estimate
To receive a retirement estimate, please complete this form, attach a copy of your
most recent Social Security Statement and send both to the HRO- Retirements
Office. If you have any questions, call a benefits specialist at 304-561-6431/6432.
4. CSRS/ CSRS Offset/ FERS
5. Daytime Phone Number:
6. Are you married?
7. Do you have any dependent children?
If so, what age(s)?
8. Projected Retirement Date?
9. Type of Retirement?
Examples Include Voluntary, Involuntary, Early, Disability, Deferred, Special
10. Have you made a deposit for any military service after December 31, 1956?
11. Would you like to elect either Full or Reduced Survivor Benefits for a
current or Former Spouse?
12. (CSRS Only) How many Sick Leave Hours will you have at retirement?
13. Will you be eligible for Social Security when you are age 62?
14. Have you ever taken a refund of your retirement contributions?
If yes, have you paid back the refund to OPM?
15. Have you made a deposit for any Temporary (FICA Only) service prior to
January 1, 1989?
16. If eligible, will you continue your health and life insurance into retirement?
17. Please provide us with either your E-Mail address to have your estimate
scanned to your or your mailing address to have your estimate mailed to you.
18. Do you have any other questions/ comments at this time?
**Please allow 2-3 weeks for delivery of your estimate.