Form Approved: OMB Number 3206-0170 Application For Refund of Retirement Deductions Federal Employees Retirement System To avoid delay in payment: (1) Complete both sides of application in full-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name (last, first, middle) in the designated field. Ensure accuracy as this will be used for identification.
3. Input your date of birth in the format mm/dd/yyyy. This is crucial for verifying your identity.
4. Provide your Social Security Number. Double-check for correctness to avoid processing delays.
5. List all other names you have used, including maiden names if applicable, to ensure all records are matched.
6. Fill in your current address completely. Note that any changes or erasures may lead to payment issues.
7. Detail your civilian and military service history accurately, including department, location, title, and periods of service.
8. Answer questions regarding further employment with the Federal government and provide necessary details if applicable.
9. Complete the certification section at the end of the form by signing and dating it to confirm all information is true.

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