Dd Form 2937 - Election Of Retirement Coverage For Reemployed Civil Service Retirement System (Csrs) And Csrs-Offset Discontinued Service Retirement (Dsr) Annuitants
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1ELECTION OF RETIREMENT COVERAGE FOR REEMPLOYED CIVIL SERVICE RETIREMENT SYSTEM (CSRS)
AND CSRS-OFFSET DISCONTINUED SERVICE RETIREMENT (DSR) ANNUITANTS
(As authorized by section 9902(h) of title 5, United States Code)
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 5 U.S.C. Chapters 83, 84, and 99; 5 U.S.C. 9902(h)(2), Provisions Relating to Reemployment;
and DoD Instruction 5400.25, DoD Civilian Personnel Management System: Volume 300, Employment of Federal Civilian Annuitants in the
Department of Defense.
PRINCIPAL PURPOSE(S): To determine and allow present or future benefits and to establish a system of records to provide Human Resource
information and system support for the DoD civilian workforce worldwide. Specifically, to document the retirement coverage selected by reemployed
CSRS discontinued service retirement annuitants.
ROUTINE USE(S): The DoD "Blanket Routine Uses" apply.
DISCLOSURE: Voluntary; however, failure to provide the requested information may result in a missed opportunity to elect retirement coverage.
1. I,
,
(Reemployed Annuitant's Full Name)
have read the "Notice to Reemployed Civil Service Retirement System (CSRS) and CSRS-Offset Discontinued Service Retirement
(DSR) Annuitants" and elect the retirement coverage checked in the box below. I understand that my election is irrevocable as
long as I am employed with the Department of Defense without a break in service (i.e., separation from Federal employment of 3
days or less). I also understand that this election will not be retroactive and will become effective the first day of the first pay
period following receipt of this form in the human resources office stated on the notice.
2.
(X one box only)
a. I elect full annuity and salary during this period of reemployment with the Department of Defense. I understand that this
means that no retirement deductions will be made from my salary nor will I have the ability to pay a deposit for such deductions
upon separation; that I will be ineligible to participate in the Thrift Savings Plan; that this period of service is ineligible for
retirement credit; and that I will be ineligible for a supplemental or redetermined annuity upon separation.
b. FOR REEMPLOYED DSR ANNUITANTS ON PERMANENT APPOINTMENTS ONLY. I elect that my annuity be terminated
and that I have CSRS or CSRS-Offset retirement deductions, as appropriate. I understand that this means that my annuity will
be terminated during the period of my reemployment; that my annuity may be reinstated after I again leave Federal employment,
or I may be entitled to either an immediate or deferred annuity based on my new separation; that retirement deductions will be
withheld from my pay; that I may elect to be covered under the Federal Employees Retirement System (FERS) if I have more
than a 3-day break in service since my retirement date; and that I am eligible to participate in the Thrift Savings Plan.
c. FOR REEMPLOYED DSR ANNUITANTS ON TERM APPOINTMENTS ELECTING RETIREMENT DEDUCTIONS FROM
PAY. I elect salary offset and CSRS or CSRS-Offset retirement deductions from my pay, as appropriate. I understand that this
means that my annuity will continue; that my pay will be reduced by the amount of annuity paid for my period of reemployment;
that retirement deductions will be withheld from my pay; that I may be eligible for a supplemental or redetermined annuity based
on how long I work during the reemployment period; and that I am eligible to participate in the Thrift Savings Plan.
d. FOR REEMPLOYED DSR ANNUITANTS ON TERM APPOINTMENTS NOT ELECTING RETIREMENT DEDUCTIONS
FROM PAY. I elect salary offset and NOT to have CSRS or CSRS-Offset retirement deductions from my pay. I understand that
this means that my annuity will continue; that my pay will be reduced by the amount of annuity paid for my period of
reemployment; that upon my separation I may make a deposit for my period of reemployment to obtain retirement credit; that I
may be eligible for a supplemental or redetermined annuity based on how long I work during the reemployment period; and that I
am not eligible to participate in the Thrift Savings Plan.
e. FOR REEMPLOYED DSR ANNUITANTS ON TEMPORARY APPOINTMENTS ELECTING RETIREMENT DEDUCTIONS
FROM PAY. I elect salary offset and CSRS or CSRS-Offset retirement deductions from my pay, as appropriate. I understand
that this means that my annuity will continue; that my pay will be reduced by the amount of annuity paid for my period of
reemployment; retirement deductions will be withheld from my pay; that I may be eligible for a supplemental or redetermined
annuity based on how long I work during the reemployment period; and that I am eligible to participate in the Thrift Savings Plan.
f. FOR REEMPLOYED DSR ANNUITANTS ON TEMPORARY APPOINTMENTS NOT ELECTING RETIREMENT
DEDUCTIONS FROM PAY. I elect salary offset and NOT to have CSRS or CSRS-Offset retirement deductions from my pay. I
understand that this means that my annuity will continue; that my pay will be reduced by the amount of annuity paid for my period
of reemployment; that upon my separation I may make a deposit for my period of reemployment to obtain retirement credit; that I
may be eligible for a supplemental or redetermined annuity based on how long I work during the reemployment period; and that I
am not eligible to participate in the Thrift Savings Plan.
3. REEMPLOYED ANNUITANT'S SIGNATURE
4. DATE SIGNED
(YYYYMMDD)
DD FORM 2937, DEC 2008
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