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{{#Wiki_filter:#
{{#Wiki_filter:feneaoq f jp J 'g UNITEDSTATES V
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+/. s NUCLEARREGULATORY COMMISSION
f jp J 'g                                 UNITEDSTATES V -
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WASHINGTON,D.C.20555-0001 n o*
            .              NUCLEAR      REGULATORY            COMMISSION
CHAIRMAN September 15,2020 TheHonorable CarolynMaloney Chairwoman, Committeeon Oversight andReform United States HouseofRepresentatives Washington, DC20515
%j@jll[!f./#/                         WASHINGTON,D.C.       20555-0001
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CHAIRMAN September     15,2020 TheHonorable   Carolyn Maloney Chairwoman,   Committeeon Oversight andReform United   StatesHouse ofRepresentatives Washington,   DC 20515


==DearMadamChairwoman:==
==DearMadamChairwoman:==
 
Onbehalf oftheU.S.Nuclear Regulatory Commission (NRC),
Onbehalf oftheU.S. Nuclear   Regulatory   Commission       (NRC),   Iampleased toreport thatonJune    2,2020,theNRCissued       newregulations tocomply            with        Security theSocial      Fraud Prevention Actof2017. Thecompletion     ofthis   rulemaking     isdetailed   intheenclosedupdated report. TheNRC's  fourthreport  also  contains  the title and identification number ofall ofthe types ofdocuments  sent bymail  that  theNRCusedduring the past                  that year  include the complete socialsecuritynumber    ofanindividual.
Iampleased toreport that onJune2,2020,theNRCissued newregulations tocomplywiththeSocial Security Fraud Prevention Actof2017.Thecompletion ofthis rulemaking isdetailed intheenclosed updated report.
Pleasefeelfreetocontact    meorhave      your    staffcontact Eugene Dacus,   Director ofthe OfficeofCongressional  Affairs, at(301)   415-1776,       if youhaveany questions orneedadditional information.
TheNRC'sfourth report alsocontains the title and identification number ofall ofthe typesofdocuments sentbymailthat theNRCusedduring thepastyearthat include the complete social security number ofanindividual.
Sincerely, Kristine     L Svinicki
Please feel free tocontact meorhaveyourstaff contact Eugene Dacus,Director ofthe Office ofCongressional
: Affairs, at(301) 415-1776, ifyouhaveany questions orneedadditional information.
Sincerely, Kristine L Svinicki


==Enclosure:==
==Enclosure:==
Asstated cc:Representative JamesComer


Asstated cc:Representative  JamesComer
NRC's Fourth Report onCompliance withtheSocial Security NumberFraudPrevention Actof2017 Planfor Compliance OnJune2,2020, the U.S.Nuclear Regulatory Commission (NRC) issued regulations (85 FR 33527)'
 
effectiveas of August 17,2020that amendits requirements inorder tocomply withthe Social Security Number Fraud Prevention Actof2017.Thisappears inpart 9oftitle 10ofthe CodeofFederal Regulations.
NRC's   Fourth Report   onCompliance       with theSocial  Security NumberFraud    Prevention Actof2017 Plan  for Compliance OnJune    2,2020,   the U.S. Nuclear Regulatory Commission   (NRC) issued           (85 regulations  FR 33527)' effective  as of August   17, 2020  thatamend  its requirements in  ordertocomply withthe Social Security Number     Fraud Prevention Act    of2017. This appears  inpart 9 oftitle 10ofthe CodeofFederal     Regulations. Theregulations nowspecify    whenthe  inclusionofanindividual's complete   Social SecurityNumber (SSN)is        necessary, maximize theuseofpartially redacted SSNswhere    feasible, require that SSNs not    bevisible onthe  outside ofanypackage   sent by mail toorfrom    theNRC,anddirect that documents sent          bymail only include theSSNofan individual whenit  isdetermined    by the head of  theagency  thatinclusion isnecessary.
Theregulationsnowspecify whentheinclusion ofanindividual's complete Social SecurityNumber (SSN)isnecessary, maximize theuseofpartially redacted SSNswherefeasible, require that SSNs notbevisible ontheoutside ofanypackage sentby mail toorfromtheNRC,anddirect that documents sentbymailonlyinclude theSSNofan individual whenitisdetermined by the head oftheagency that inclusion isnecessary.
Thetable   below  liststhe  documents    sent by mailthat theNRCused    during the pastyear andthat   included anindividual's   complete SSN, which wasnot    visible onthe outsideofany package. Approximately       83percent ofthelisted documents areforms     used acrossthe Federal Government.
Thetable belowlists thedocuments sent by mailthat theNRCusedduring thepastyear andthat included anindividual's complete SSN, whichwasnotvisible ontheoutside ofany package.
Listing ofDocuments       Sent  byMail Document   Title                                                 Document                 Number identification Cumulative Occupational       DoseHistory                         NRC Form4 Occupational   DoseRecord       fora Monitoring  Period           NRC Form 5 Travel Voucher                                                   NRCForm 64 Contractor,Other   Government     Agency   Employee, or         NRCForm89 Foreign Assignee   Badge    Request Personnel Security   Clearance   Request   andNotification       NRCForm236 Request forAccess   Authorization                               NRCForm237 Request forVisit                                                 NRCForm277 Certification ofMedical     Examination   byFacility Licensee NRCForm396 Freedom ofInformation     -
Approximately 83percent ofthe listed documents areforms usedacross theFederal Government.
Privacy ActRecord   Request NRCForm507 Request foranAuthorization     ofRelease   ofDosimetry NRCForm525 Records Authorization toReceive     anNRCDosimeter                       NRCForm537 Request forNRCContractor       Building Access   Authorization NRCForm850A Request forNRCContractor       information Technology (IT)NRCForm850B Access Authorization 1 https;//vovw,goyinfo.gov/contenj/pkgi@202070.6-02/pdf/2020:11.900 pdf Enclosure
Listing ofDocuments SentbyMail Document Title Document identificationNumber Cumulative Occupational DoseHistory NRC Form4 Occupational DoseRecord foraMonitoring Period NRC Form 5 Travel Voucher NRCForm 64 Contractor, Other Government Agency
: Employee, or NRCForm89 Foreign Assignee BadgeRequest Personnel Security Clearance Request andNotification NRCForm236 Request forAccess Authorization NRCForm237 Request forVisit NRCForm277 Certification ofMedical Examination byFacility LicenseeNRCForm396 Freedom ofInformation
- Privacy ActRecord Request NRCForm507 Request foranAuthorization ofRelease ofDosimetry NRCForm525 Records Authorization toReceive anNRCDosimeter NRCForm537 Request forNRCContractor Building Access Authorization NRCForm850A Request forNRCContractor information Technology (IT)NRCForm850B Access Authorization 1https;//vovw,goyinfo.gov/contenj/pkgi@202070.6-02/pdf/2020:11.900 pdf Enclosure


Document   Title                                         Document      Identification Number Request   forNRCContractor   Security   Clearance       NRCForm850C Requestfor   Employment Information Centers  for        & Medicaid Medicare Services   L564 CertificateofRelease    orDischargefrom    Active Duty   DD-214 Federal Employee's   Notice ofTraumatic  InjuryandClaim U.S. Department   ofLabor CA-1 forContinuation   ofPay/Compensation Notice ofOccupationalDisease andClaim       for U.S. Department   ofLabor CA-2 Compensation Claim forCompensation                                   U.S. Department   ofLabor CA-7 Fingerprint Cards                                         FD258andSF87 Miscellaneous  Income                                    Internal Revenue       (IRS)
Document Title DocumentIdentification Number Request forNRCContractor Security Clearance NRCForm850C Centers forMedicare
Service Form1099 Employee   Express   Health Benefits History Report       Noidentification number Payroll Deductions   for Post-1956   Military Deposit Noidentification  number Memorandum Post-1956 Military Deposit Payment   Election Noidentification number Memorandum Quick-Pay Worksheet   for Employee    DeathinService No identification number Declaration for  Federal  Employment                     OF 306 MilitaryDeposit  Worksheet                               OPM-1514 MilitaryService  Deposit   Election                       OPM-1515 Estimated Earnings   During Military Service           RI20-97 CertificationofService  Performed   asa Law Enforcement   Officer, Firefighter,Nuclear Materials     RI20-124 Courier, Customs   andBorder Protection Officer 535Service   , orAir TrafficController Assignment:   Federal   Employees'   Group LifeInsurance RI76-10 (FEGLl) Program Questionnaire   for National Security                     SF86 Self-IdentificationofDisability                          SF256 Classified Information Nondisclosure   Agreement         SF312 Verificationofa Military  Retiree's ServiceinNonwartime SF813 Campaigns   orExpeditions Record ofLeave  Data                                    SF1150 2
&Medicaid Requestfor Employment Information Services L564 Certificate ofRelease orDischargefromActive Duty DD-214 Federal Employee's Notice ofTraumaticInjury andClaim U.S.Department ofLaborCA-1 forContinuation ofPay/Compensation Notice ofOccupationalDisease andClaim for U.S.Department ofLabor CA-2 Compensation Claim forCompensation U.S.Department ofLabor CA-7 Fingerprint Cards FD258andSF87 Internal Revenue Service (IRS)
Miscellaneous Income Form1099 Employee Express Health Benefits History Report Noidentification number Payroll Deductions forPost-1956 Military Deposit Noidentificationnumber Memorandum Post-1956 Military Deposit Payment Election Noidentification number Memorandum Quick-Pay Worksheet forEmployee DeathinService No identification number Declaration forFederal Employment OF 306 Military Deposit Worksheet OPM-1514 Military Service Deposit Election OPM-1515 Estimated Earnings During Military Service RI20-97 Certification ofService Performed asaLaw Enforcement
: Officer, Firefighter, Nuclear Materials RI20-124
: Courier, Customs andBorder Protection Officer 535Service
, orAirTraffic Controller Assignment:
Federal Employees' GroupLife Insurance RI76-10 (FEGLl)
Program Questionnaire forNational Security SF86 Self-Identification ofDisability SF256 Classified Information Nondisclosure Agreement SF312 Verification ofaMilitary Retiree's Service inNonwartime SF813 Campaigns orExpeditions Record ofLeaveData SF1150 2


Document     Title                                               DocumentIdentification Number Designation   ofBeneficiary: Unpaid         Compensation     of   SF1152 Deceased     Civilian   Employee Claim for Compensation       ofDeceased     Civilian Employee SF1153 Application   for  Death  Benefits   (CivilService  Retirement SF2800 System   (CSRS))
Document Title DocumentIdentification Number Designation ofBeneficiary: Unpaid Compensation of SF1152 Deceased Civilian Employee Claim for Compensation ofDeceased Civilian Employee SF1153 Application forDeath Benefits (Civil Service RetirementSF2800 System (CSRS))
Documentation       andElections inSupportofApplication for Death  Benefits    WhenDeceased Was          anEmployee SF2800A attheTime    ofDeath      (CSRS)
Documentation andElections inSupportofApplication forDeathBenefits WhenDeceased WasanEmployee SF2800A attheTimeofDeath (CSRS)
Application   for  Immediate    Retirement   (CSRS)               SF2801 Certified Summary      ofFederal    Service (CSRS)               SF2801-1 Spouse's   Consent     toSurvivor     Election                   SF2801-2 Schedules   A,B,C:A-Military           Service Information, B-Military   Retired   Pay, C-Federal     Employees             SF2801-ABC Compensation Schedule   D:Agency      Checklist    ofImmediate   Retirement SF2801-D Procedures Application for  Refund    ofRetirement     Deductions           SF 2802 CSRS Application toMakeDeposit           orRedeposit   (CSRS)         SF 2803 Application toMakeVoluntary           Contributions (CSRS)       SF2804 Designation   ofBeneficiary     (CSRS)                           SF2808 Health Benefits     Election Form                               SF2809 Notice ofChange      inHealth    Benefits Enrollment           SF2810 Life Insurance     Election (Federal   Employees'   Group  Life SF2817 Insurance   Program       (FEGLl))   Program Continuation   ofLife   Insurance   Coverage asan SF2818 Annuitant   orCompensationer         (FEGLI Program)
Application forImmediate Retirement (CSRS)
Notice ofConversion       Privilege   (FEGLI Program)           SF2819 Certification ofInsured     Employee's     Retired Status SF2820 (FEGLl   Program)
SF2801 Certified SummaryofFederal Service (CSRS)
Agency    Certification  ofInsurance     Status (FEGLI           SF2821 Program)
SF2801-1 Spouse's Consent toSurvivor Election SF2801-2 Schedules A,B,C:A-Military Service Information, B-Military Retired Pay,C-Federal Employees SF2801-ABC Compensation Schedule D:AgencyChecklist ofImmediate Retirement SF2801-D Procedures Application forRefund ofRetirement Deductions SF 2802 CSRS Application toMakeDeposit orRedeposit (CSRS)
Request   for Insurance      (FEGLI   Program)                   SF2822 Designation   ofBeneficiary     (FEGLI   Program)               SF2823 Designation   ofBeneficiary     (Federal   Employees             SF3102 Retirement   S stemFERS 3
SF 2803 Application toMakeVoluntary Contributions (CSRS)
SF2804 Designation ofBeneficiary (CSRS)
SF2808 Health Benefits Election Form SF2809 Notice ofChangeinHealth Benefits Enrollment SF2810 Life Insurance Election (Federal Employees' GroupLife SF2817 Insurance Program (FEGLl))
Program Continuation ofLife Insurance Coverage asan SF2818 Annuitant orCompensationer (FEGLI Program)
Notice ofConversion Privilege (FEGLI Program)
SF2819 Certification ofInsured Employee's Retired Status SF2820 (FEGLl Program)
AgencyCertification ofInsurance Status (FEGLI SF2821 Program)
Request forInsurance (FEGLI Program)
SF2822 Designation ofBeneficiary (FEGLI Program)
SF2823 Designation ofBeneficiary (Federal Employees SF3102 Retirement S stemFERS 3


Document       Title                                           Documentidentification Number Register   ofSeparations   andTransfers   (FERS)             SF3103 Application   for Death  Benefits (FERS)                     SF3104 Documentation       andElectioninSupport     ofApplication for Death     Benefits When Deceased Was      anEmployee    at   SF3104B theTimeofDeath Application   for Refund ofRetirement   Deductions   (FERS)SF3106 Application   for Immediate Retirement   (FERS)             SF3107 Certified   Summary    ofFederal Service (FERS)               SF3107-1 Spouse's     Consent   toSurvivorElection                     SF3107-2 Schedules     A,B,andC:A-Military Service Information, B-Military     Retired Pay, C-Federal   Employees           SF3107-ABC Compensation       Information Schedule     D:Agency    Checklist ofimmediate Retirement    SF3107-D Procedures     (FERS)
Document Title Document identification Number Register ofSeparations andTransfers (FERS)
Application   toMakeService     Credit Payment   (FERS)     SF3108 Application   ToPayMilitary   Deposit forMilitary Service   SF3108A Performed     After December   31 1956 Election   ofCoverage   (FERS)                               SF 3109 Former    Spouse's   Consent toFERSElection     (FERS) SF3110 Documentation       inSupport ofDisability Retirement SF3112 Application Applicant's   Statement   ofDisability (InConnection  with Disability   Retirement   Under  theCSRSorFERS)               SF3112A Thrift Savings   Plan  Election Form                         TSP-1 Thrift Savings   Plan  Catch-Up Contribution Election       TSP-1-C Employee's     Withholding Allowance   Certificate           IRSFormW-4 Withholding     Certificatefor Pension  orAnnuity   Payments IRSFormW-4P U.S. Department     ofState Official Passport   Applications   DS-82 (Renewal Application) 4
SF3103 Application forDeathBenefits (FERS)
SF3104 Documentation andElectioninSupport ofApplication for Death Benefits When Deceased WasanEmployee at SF3104B theTimeofDeath Application for Refund ofRetirement Deductions (FERS)SF3106 Application for Immediate Retirement (FERS)
SF3107 Certified SummaryofFederal Service (FERS)
SF3107-1 Spouse's Consent toSurvivorElection SF3107-2 Schedules A,B,andC:A-Military Service Information, B-Military Retired
: Pay, C-Federal Employees SF3107-ABC Compensation Information Schedule D:AgencyChecklist ofimmediateRetirement SF3107-D Procedures (FERS)
Application toMakeService Credit Payment (FERS)
SF3108 Application ToPayMilitary Deposit forMilitary Service SF3108A Performed After December 31 1956 Election ofCoverage (FERS)
SF 3109 FormerSpouse's Consent toFERSElection (FERS)
SF3110 Documentation inSupport ofDisability Retirement SF3112 Application Applicant's Statement ofDisability (In Connection with Disability Retirement UndertheCSRSorFERS)
SF3112A Thrift Savings PlanElection Form TSP-1 Thrift Savings PlanCatch-Up Contribution Election TSP-1-C Employee's Withholding Allowance Certificate IRSFormW-4 Withholding Certificate forPension orAnnuity Payments IRSFormW-4P U.S.Department ofState Official Passport Applications DS-82(Renewal Application) 4


Identical   letters sent  to:
Identical letters sentto:
The Honorable       Carolyn Maloney                 TheHonorable JohnLarson Chairwoman,       Committee   onOversight                   Subcommittee Chairman,             Security onSocial andReform                                           House      onWays Committee    andMeans United   States   House   ofRepresentatives               States United  HouseofRepresentatives Washington,       DC   20515                                   DC20515 Washington, cc:Representative         James   Comer                           TomReed cc:Representative TheHonorable         Richard Neal Chairman,     Committee     on Ways andMeans United   States   House    ofRepresentatives Washington,       DC 20515 cc:Representative         Kevin Brady TheHonorable         RonJohnson Chairman,     Committee     onHomeland       Security andGovernmental         Affairs United   States   Senate Washington,       DC 20510 cc:Senator       Gary  C.Peters TheHonorable         Chuck  Grassley Chairman,     Committee     onFinance United   States   Senate Washington,       DC 20510 cc:Senator       RonWyden TheHonorable         Frank Pallone Chairman,     Committee     onEnergy andCommerce United   States   House  ofRepresentatives Washington,       DC 20515 cc:Representative       Greg  Walden TheHonorable       JohnA.Barrasso Chairman,     Committee     onEnvironment andPublic       Works United   States   Senate Washington,     DC 20510 cc:Senator       Thomas    R.Carper TheHonorable       Gerald   Connolly Chairman,     Subcommittee     on Government       Operations House    Committee    onOversight   andReform United   States   House  ofRepresentatives Washington,     DC 20515 cc: Representative     Jody  Hice}}
The Honorable Carolyn Maloney TheHonorable JohnLarson Chairwoman, Committee onOversight
: Chairman, Subcommittee onSocial Security andReform HouseCommittee onWays andMeans United States House ofRepresentatives United States HouseofRepresentatives Washington,DC 20515 Washington, DC20515 cc:Representative James Comer cc:Representative TomReed TheHonorable Richard Neal
: Chairman, Committee on Ways andMeans United States HouseofRepresentatives Washington, DC20515 cc:Representative Kevin Brady TheHonorable RonJohnson
: Chairman, Committee onHomeland Security andGovernmental Affairs United States Senate Washington, DC20510 cc:Senator GaryC.Peters TheHonorable ChuckGrassley
: Chairman, Committee onFinance United States Senate Washington, DC 20510 cc:Senator RonWyden TheHonorable Frank Pallone
: Chairman, Committee onEnergy andCommerce United States HouseofRepresentatives Washington, DC 20515 cc:Representative GregWalden TheHonorable JohnA.Barrasso
: Chairman, Committee onEnvironment andPublic Works United States Senate Washington, DC 20510 cc:Senator ThomasR.Carper TheHonorable Gerald Connolly
: Chairman, Subcommittee on Government Operations HouseCommittee onOversight andReform United States HouseofRepresentatives Washington, DC 20515 cc:Representative JodyHice}}

Latest revision as of 08:16, 3 December 2024

09-15-20 Letter to the Honorable Carolyn Maloney Et Al., from Chairman Svinicki Submits the Fourth Response to the Social Security Number Fraud Prevention Act of 2017 (Pl 115-59)
ML20218A522
Person / Time
Issue date: 09/15/2020
From: Kristine Svinicki
NRC/Chairman, NRC/OCM
To: Barrasso J, Connolly G, Grassley C, Rachel Johnson, Larson J, Maloney C, Neal R, Pallone F
US HR (House of Representatives), US HR, Comm on Energy & Commerce, US HR, Comm on Government Reform & Oversight, US HR, Comm on Oversight and Government Reform, US HR, Comm on Ways and Means, US HR, Subcomm on Government Operations, US HR, Subcomm on Social Security, US SEN (Senate), US SEN, Comm on Finance, US SEN, Comm on Homeland Security & Governmental Affairs
Sally Hardy, 301-415-5607
References
CORR-20-0089, PL 115-59, SRM-PL115-59-2-OCIO
Download: ML20218A522 (6)


Text

feneaoq f jp J 'g UNITEDSTATES V

+/. s NUCLEARREGULATORY COMMISSION

%j@jll[!f./#/

WASHINGTON,D.C.20555-0001 n o*

CHAIRMAN September 15,2020 TheHonorable CarolynMaloney Chairwoman, Committeeon Oversight andReform United States HouseofRepresentatives Washington, DC20515

DearMadamChairwoman:

Onbehalf oftheU.S.Nuclear Regulatory Commission (NRC),

Iampleased toreport that onJune2,2020,theNRCissued newregulations tocomplywiththeSocial Security Fraud Prevention Actof2017.Thecompletion ofthis rulemaking isdetailed intheenclosed updated report.

TheNRC'sfourth report alsocontains the title and identification number ofall ofthe typesofdocuments sentbymailthat theNRCusedduring thepastyearthat include the complete social security number ofanindividual.

Please feel free tocontact meorhaveyourstaff contact Eugene Dacus,Director ofthe Office ofCongressional

Affairs, at(301) 415-1776, ifyouhaveany questions orneedadditional information.

Sincerely, Kristine L Svinicki

Enclosure:

Asstated cc:Representative JamesComer

NRC's Fourth Report onCompliance withtheSocial Security NumberFraudPrevention Actof2017 Planfor Compliance OnJune2,2020, the U.S.Nuclear Regulatory Commission (NRC) issued regulations (85 FR 33527)'

effectiveas of August 17,2020that amendits requirements inorder tocomply withthe Social Security Number Fraud Prevention Actof2017.Thisappears inpart 9oftitle 10ofthe CodeofFederal Regulations.

Theregulationsnowspecify whentheinclusion ofanindividual's complete Social SecurityNumber (SSN)isnecessary, maximize theuseofpartially redacted SSNswherefeasible, require that SSNs notbevisible ontheoutside ofanypackage sentby mail toorfromtheNRC,anddirect that documents sentbymailonlyinclude theSSNofan individual whenitisdetermined by the head oftheagency that inclusion isnecessary.

Thetable belowlists thedocuments sent by mailthat theNRCusedduring thepastyear andthat included anindividual's complete SSN, whichwasnotvisible ontheoutside ofany package.

Approximately 83percent ofthe listed documents areforms usedacross theFederal Government.

Listing ofDocuments SentbyMail Document Title Document identificationNumber Cumulative Occupational DoseHistory NRC Form4 Occupational DoseRecord foraMonitoring Period NRC Form 5 Travel Voucher NRCForm 64 Contractor, Other Government Agency

Employee, or NRCForm89 Foreign Assignee BadgeRequest Personnel Security Clearance Request andNotification NRCForm236 Request forAccess Authorization NRCForm237 Request forVisit NRCForm277 Certification ofMedical Examination byFacility LicenseeNRCForm396 Freedom ofInformation

- Privacy ActRecord Request NRCForm507 Request foranAuthorization ofRelease ofDosimetry NRCForm525 Records Authorization toReceive anNRCDosimeter NRCForm537 Request forNRCContractor Building Access Authorization NRCForm850A Request forNRCContractor information Technology (IT)NRCForm850B Access Authorization 1https;//vovw,goyinfo.gov/contenj/pkgi@202070.6-02/pdf/2020:11.900 pdf Enclosure

Document Title DocumentIdentification Number Request forNRCContractor Security Clearance NRCForm850C Centers forMedicare

&Medicaid Requestfor Employment Information Services L564 Certificate ofRelease orDischargefromActive Duty DD-214 Federal Employee's Notice ofTraumaticInjury andClaim U.S.Department ofLaborCA-1 forContinuation ofPay/Compensation Notice ofOccupationalDisease andClaim for U.S.Department ofLabor CA-2 Compensation Claim forCompensation U.S.Department ofLabor CA-7 Fingerprint Cards FD258andSF87 Internal Revenue Service (IRS)

Miscellaneous Income Form1099 Employee Express Health Benefits History Report Noidentification number Payroll Deductions forPost-1956 Military Deposit Noidentificationnumber Memorandum Post-1956 Military Deposit Payment Election Noidentification number Memorandum Quick-Pay Worksheet forEmployee DeathinService No identification number Declaration forFederal Employment OF 306 Military Deposit Worksheet OPM-1514 Military Service Deposit Election OPM-1515 Estimated Earnings During Military Service RI20-97 Certification ofService Performed asaLaw Enforcement

Officer, Firefighter, Nuclear Materials RI20-124
Courier, Customs andBorder Protection Officer 535Service

, orAirTraffic Controller Assignment:

Federal Employees' GroupLife Insurance RI76-10 (FEGLl)

Program Questionnaire forNational Security SF86 Self-Identification ofDisability SF256 Classified Information Nondisclosure Agreement SF312 Verification ofaMilitary Retiree's Service inNonwartime SF813 Campaigns orExpeditions Record ofLeaveData SF1150 2

Document Title DocumentIdentification Number Designation ofBeneficiary: Unpaid Compensation of SF1152 Deceased Civilian Employee Claim for Compensation ofDeceased Civilian Employee SF1153 Application forDeath Benefits (Civil Service RetirementSF2800 System (CSRS))

Documentation andElections inSupportofApplication forDeathBenefits WhenDeceased WasanEmployee SF2800A attheTimeofDeath (CSRS)

Application forImmediate Retirement (CSRS)

SF2801 Certified SummaryofFederal Service (CSRS)

SF2801-1 Spouse's Consent toSurvivor Election SF2801-2 Schedules A,B,C:A-Military Service Information, B-Military Retired Pay,C-Federal Employees SF2801-ABC Compensation Schedule D:AgencyChecklist ofImmediate Retirement SF2801-D Procedures Application forRefund ofRetirement Deductions SF 2802 CSRS Application toMakeDeposit orRedeposit (CSRS)

SF 2803 Application toMakeVoluntary Contributions (CSRS)

SF2804 Designation ofBeneficiary (CSRS)

SF2808 Health Benefits Election Form SF2809 Notice ofChangeinHealth Benefits Enrollment SF2810 Life Insurance Election (Federal Employees' GroupLife SF2817 Insurance Program (FEGLl))

Program Continuation ofLife Insurance Coverage asan SF2818 Annuitant orCompensationer (FEGLI Program)

Notice ofConversion Privilege (FEGLI Program)

SF2819 Certification ofInsured Employee's Retired Status SF2820 (FEGLl Program)

AgencyCertification ofInsurance Status (FEGLI SF2821 Program)

Request forInsurance (FEGLI Program)

SF2822 Designation ofBeneficiary (FEGLI Program)

SF2823 Designation ofBeneficiary (Federal Employees SF3102 Retirement S stemFERS 3

Document Title Document identification Number Register ofSeparations andTransfers (FERS)

SF3103 Application forDeathBenefits (FERS)

SF3104 Documentation andElectioninSupport ofApplication for Death Benefits When Deceased WasanEmployee at SF3104B theTimeofDeath Application for Refund ofRetirement Deductions (FERS)SF3106 Application for Immediate Retirement (FERS)

SF3107 Certified SummaryofFederal Service (FERS)

SF3107-1 Spouse's Consent toSurvivorElection SF3107-2 Schedules A,B,andC:A-Military Service Information, B-Military Retired

Pay, C-Federal Employees SF3107-ABC Compensation Information Schedule D:AgencyChecklist ofimmediateRetirement SF3107-D Procedures (FERS)

Application toMakeService Credit Payment (FERS)

SF3108 Application ToPayMilitary Deposit forMilitary Service SF3108A Performed After December 31 1956 Election ofCoverage (FERS)

SF 3109 FormerSpouse's Consent toFERSElection (FERS)

SF3110 Documentation inSupport ofDisability Retirement SF3112 Application Applicant's Statement ofDisability (In Connection with Disability Retirement UndertheCSRSorFERS)

SF3112A Thrift Savings PlanElection Form TSP-1 Thrift Savings PlanCatch-Up Contribution Election TSP-1-C Employee's Withholding Allowance Certificate IRSFormW-4 Withholding Certificate forPension orAnnuity Payments IRSFormW-4P U.S.Department ofState Official Passport Applications DS-82(Renewal Application) 4

Identical letters sentto:

The Honorable Carolyn Maloney TheHonorable JohnLarson Chairwoman, Committee onOversight

Chairman, Subcommittee onSocial Security andReform HouseCommittee onWays andMeans United States House ofRepresentatives United States HouseofRepresentatives Washington,DC 20515 Washington, DC20515 cc:Representative James Comer cc:Representative TomReed TheHonorable Richard Neal
Chairman, Committee on Ways andMeans United States HouseofRepresentatives Washington, DC20515 cc:Representative Kevin Brady TheHonorable RonJohnson
Chairman, Committee onHomeland Security andGovernmental Affairs United States Senate Washington, DC20510 cc:Senator GaryC.Peters TheHonorable ChuckGrassley
Chairman, Committee onFinance United States Senate Washington, DC 20510 cc:Senator RonWyden TheHonorable Frank Pallone
Chairman, Committee onEnergy andCommerce United States HouseofRepresentatives Washington, DC 20515 cc:Representative GregWalden TheHonorable JohnA.Barrasso
Chairman, Committee onEnvironment andPublic Works United States Senate Washington, DC 20510 cc:Senator ThomasR.Carper TheHonorable Gerald Connolly
Chairman, Subcommittee on Government Operations HouseCommittee onOversight andReform United States HouseofRepresentatives Washington, DC 20515 cc:Representative JodyHice