FEDERAL BENEFITS ANALYSIS QUESTIONNAIRE

Personal
Information
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Key
 Dates
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Birth Date: 

Spouse
Information
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Retirement Type: 

Select One Regular Optional Mandatory

Hours Saved Each Pay Period:
Select One 0 1 2 3 4 5 6 7 8

Pay
Check
Data

Federal Employees Group Life Insurance

Basic:

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At Age 65 Reduce By: Select One 0% 50% 75%

Option A:

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Option B:

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Multiplier: 0 1 2 3 4 5 Time(s)

Reduce to 0 After Age 65? Select One Yes No

Option C:

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Multiplier: 0 1 2 3 4 5 Time(s)

Reduce to 0 After Age 65? Select One Yes No

Dependents
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  Age                 Age               Age                Age:
After 22               After 22             After 22               After 22

Thrift Savings Plan

L Fund: $ C Fund: $ F Fund: $
G Fund: $ I Fund: $ S Fund: $
L Fund: select 2040 2030 2020 2010 Income None

Percent of Annual Salary Invested Each Year: 0 1 2 3 4 5 6 7 8 9 10 (CSRS: 5% max, FERS: 10% max)

Distribution
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C Fund: %         F Fund: %         G Fund: %

Withdrawal
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I plan to withdraw my money: Select One Lump Sum Monthly Amount Annuity

If I selected a Monthly Amount, I will distribute my Savings as follows:

C Fund: %         F Fund: %         G Fund: %

My withdrawal will start on: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 2045 2046 2047 2048 2049 2050

Press the SUBMIT button when you are finished. This will send this form to us for the development of your personalized Federal Employee Benefits Analysis.