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FEDERAL BENEFITS ANALYSIS QUESTIONAIRE
Employee Name : Employee’s Birthday :
Spouses’ Name : Spouse’s Birthday:
Address : City/State : Zip Code :
Work Phone: Evening Phone: Mobile Phone:
Work E Mail : Personal E Mail :
Preferred Contact Method : Is your spouse employed by the Federal Government?
Agency : Location : Seminar Date :
 
Employee Information
Sources : Last Earnings & Leave Statement and latest TSP statement from MyEPPstatement@https://www.nfc.usda.gov/personal/ep
EmployeeType: CSRS FERS OFFSET NON LAW LAW POSTAL OTHER
Employee’s Service Computation Date    (SCD includes military time if already bought back) :
Desired Retirement Date : 1st Available or Current Grade: Current Step:
CSRS Sick Leave:  Hours Saved per Pay Period CSRS Sick Leave:  Total Hours Saved
FERS (only):  Estimated Monthly Social Security Benefit or Best Estimate
Current Salary : Additional pay information I should know :
Do you have military time to buy back : Do you use nicotine? If so describe:
Federal Employees Group Life Insurance Coverage & Personal Insurance
FEGLI : Basic : Option A: Option B: Option C: Spouse Dependents Current Ages

Do You Have Personal Life Insurance

Face Amount Term Whole lIfe Univeral Life
Do You Plan on Keeping Your Group Life Insurance once retired ?
Thrift Savings Plan & Personal Retirement Plans

Current Balances in each Fund: C :

F : G : I : S : L :

% of Salary per pay period

% of Contribution
in Each Fund: C:
F: G : I : S: L:

Do you have any
personal IRA's

Amt Do you have any other Retirement? Plans Amt
Do you have any other investments that
you plan to use for retirement?  Stocks
Bonds Got Bonds

Mutual Funds

Managed Accts Spouse's Retirement Plan
Financial Education
I would like to learn more about the
following products and services :
Long Term Care : Life Insurance :
Roth IRA’s 529 Plans Mutual Funds REITS Managed Accounts Other
Information/Questions/Comments :
 
Please Fax to 1-502-633-1674
 
 
 



 
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