Retirement Appointment RequestFull Name*Badge/Employee Number*Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Phone*Date of Last Estimate MM slash DD slash YYYY Retirement Month*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberRetirement Year*20222023Total vacation remaining at retirement (in full weeks)Accumulated sick leave at retirement, in days (if applicable)Have you worked since January 1 of this year without any breaks in service?* Yes NoIf you have answered "no" to the above, please explain.What total amount of time in full months (if any) has been lost due to breaks in service for suspension, discharge, exhausted sick leave, etcMarital Status* Single MarriedSelect a retirement option (this election is non-binding)*No Option100% With Pop-up75% With Pop-up66 2/3% With Pop-up50% With Pop-up33 1/3% With Pop-up25% With Pop-up100% Without Pop-up75% Without Pop-up66 2/3 % Without Pop-up50% Without Pop-up33 1/3 % Without Pop-up25% Without Pop-upTerm Certain – 5yrsTerm Certain – 10yrsTerm Certain – 15yrsI'm not sureCAPTCHA