Federal Benefit Review Information Profile - Brook Fed

Federal Benefit Review Information Profile

Name

Birth Date

Address

City & State

Zip Code

Spouse/Partner

Birth Date

Children's Ages

Is your spouse a Federal employee?

If so, which agency?

Cell Phone

Work Phone

Other

Home Email

Work Email

Preferred Contact: Email: ( Personal Work) Phone: ( Cell Work Other) Time ____________________________________________________________________________________________

TO PROVIDE YOU WITH AN ACCURATE ANALYSIS, PLEASE PROVIDE INFORMATION BELOW

CSRS CSRS Offset / Date of Offset

FERS FERS Transfer / Date

My Service Computation Date (SCD)

LEO LEO SCD

Anticipated Retirement:

Age

OR Date

Sick Leave Balance

Social Security @ 62

Pay Grade and Step and Temporary/Refunded Time:

I am a GS WG WL/WS Other

Grade

Step

Annual Base Salary with Locality $

Part Time Hours Worked YES NO

I took a refund of contributions and did not pay it back. YES NO Amount/Date

I have civilian service credit in my SCD, where I did not pay into CSRS/FERS retirement. YES NO

Federal Employees Group Life Insurance (FEGLI):

Basic Option A Option B (x 1-5)

Option C (x 1-5)

Are you a smoker? YES NO

Thrift Savings Plan:

Balance in Funds: L$________ C$________ F$________ G$________ I$________ S$________Which L

Contribution: ________% or $__________per pay period. If catch-up (CUC), how much? $__________

Allocation of future contributions: L_____% C_____% F_____% G_____% I_____% S_____% Which L

Military Time: (or Peace Corp / Vista)

I have Prior Active Military Time YES NO Years

Months

Have you bought back your active military time? YES NO Date From

To

Is your military time included in above SCD? (Include Retired Active Duty) YES NO

SUBMIT THE FOLLOWING INFORMATION FOR A FREE BENEFIT ANALYSIS Completed Profile Copy of a recent pay stub/LES TSP statement Social Security statement

VIA EMAIL TO JVISNER@ OR VIA FAX TO (262) 784-7206

SUBMIT INFORMATION VIA EMAIL TO JVISNER@ OR VIA FAX TO (262) 784-7206

675 N. Barker Rd., Suite #200, Brookfield, WI 53045 () Phone: (262) 456-5514, Fax: (262) 784-7206, Email: jvisner@

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