Reconsideration Of Dcrbs Decision Earned Income Review Form
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1
2District of Columbia Retirement Board (DCRB)
Benefits Department
900 7th Street, NW, 2nd Floor Washington, DC 20001
Telephone: (202) 343-3272 Toll Free: (866) 456-3272 Fax: (202) 566-5001
Reconsideration of DCRB’s Decision
Earned Income Review
Instructions
The District of Columbia Retirement Board (DCRB), the Plan
By hand delivery to:
Administrator, issued a decision:
DC Retirement Board
Attn: Chief Benefits Officer
900 7th Street, NW 2nd Floor
Terminating your disability annuity
Washington, DC 20001
DCRB’s decision is explained in the attached letter. If you
If your reconsideration request is hand delivered it must be
disagree with this decision, you may request reconsideration
received no later than 60 calendar days after receipt/
in writing by completing this form or by attaching a statement
notification of DCRB’s initial decision (DC Code §1-751(d)(2)).
to the completed form. DCRB’s reconsideration rules are at
DC Code §1-751(d).
By fax to: (202) 566-5001
General Instructions
If your reconsideration request is delivered by fax, it must be
received no later than 60 calendar days after receipt/
1. Please read all items carefully.
notification of DCRB’s initial decision (DC Code §1-751(d)(2)).
2. Type or print in ink.
You may lose your right to reconsideration if you do not respond
to DCRB within 60 days or obtain an extension of this deadline.
3. Complete all items on the form. If a question does not
If you need more time, please explain why in writing to DCRB by
apply, answer “No” or “None". Do not leave it blank. If
mail or fax.
answers require additional space, you may attach
additional sheets of paper. Include your name and date
Detailed Instructions
in the upper right corner of each additional sheet of
paper.
Most of the items on the form are self-explanatory. Instructions
are provided below for those items identified which may require
4. Sign and date this form in Section III.
further explanation.
5. Return the reconsideration request by mail, hand
Section I – Personal Data
delivery, or fax.
Items 1 through 6: Provide your name, address, birth date, and
other personal information.
By mail:
DC Retirement Board
Section II – Basis for Your Reconsideration Request
Attn: Chief Benefits Officer
In order to succeed in your reconsideration request, you must
900 7th Street, NW 2nd Floor
explain the reason for the reconsideration and you will have to
Washington, DC 20001
prove that the facts on which DCRB based its decision were
incorrect or that DCRB misinterpreted the laws that apply to the
If your reconsideration request is returned by mail, it
calculation of your benefit.
must be postmarked within 60 calendar days after
receipt/notification of DCRB’s decision letter (DC Code
The initial decision will stand unless you are able to prove that it
§1-751(d)(2)).
is incorrect. To prove your case, it will be best if you have
documents that support your position.
If you do not have
documents, but believe that the Retirement Plan, the District of
Columbia
government,
or
another
government
agency,
such as the Office of Personnel Management (OPM),
has a copy of such documents, you are entitled to obtain a
copy of those documents and review them before completing
your request for reconsideration.
DCRBFormRRD-300
continued back page
Revised 07/2014
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