RI 20-123 Request for Case Review for Enhanced Disability Annuity

United States
Office of Personnel Management
Retirement Operations
Boyers, PA 16017

Form Approved
OMB Number 3206-0254

Request for Case Review for Enhanced Disability Annuity Benefit
Your full name

If you are receiving a survivor annuity, full name of the former federal employee who performed the service

Claim number (beginning with CSA or CSF)

Your daytime telephone number

Your email address

My annuity benefit includes credit for service performed under the Civil Service Retirement System (CSRS) or the
Federal Employees' Retirement System (FERS) as: (check all that are appropriate)
Law Enforcement Officer
Firefighter
Nuclear Materials Courier performed with the Department of Energy on or after October 1, 1977
Customs and Border Protection Officer on or after July 6, 2008
Member of the Capitol Police
Member of the Supreme Court Police
Congressional Employee
Member of Congress
Air Traffic Controller

We will respond to your request in writing to your address of record.
Retirement Operations
Public Burden Statement
We estimate providing this information takes an average 5 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 U.S. Office of Personnel Management, Retirement Services Publications Team, (3206-0254), Washington, D.C. 20415-3430.
The OMB number, 3206-0254, is currently valid. OPM may not collect this information, and you are not required to respond, unless this number is
displayed.
Added previous editions usability

RI 20-123
May 2011