Header: requester and system
Name, date of request, office symbol, phone number and the retirement system: CSRS, CSRS-Offset or FERS.
GSA2828
Request for Retirement Estimate
- Agency
- GSA
- Revision
- Rev. 7/2021
- Fillable fields
- 116
- Pages
- 5
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 2828: Request for Retirement Estimate
GSA Form 2828, Request for Retirement Estimate, is a General Services Administration form. Its footer reads GSA 2828 (REV. 7/2021), and GSA hosts it in its forms library. GSA's page lists HRM 5440.6 as its authority or regulation.
The requester gives a name, the date of the request, an office symbol and a phone number, and checks the retirement system: CSRS, CSRS-Offset or FERS. Items 1 to 15 cover the type of annuity computation, up to three estimate dates with sick leave hours, past service and refunds, survivor annuity, health, life, dental and vision coverage to carry into retirement, military service and federal tax withholding. General Instructions on pages 4 and 5 explain each item.
The form says the calculation is only an estimate and that the actual annuity will be determined by the U.S. Office of Personnel Management. You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 2828
Items 1 and 2: type and dates
The type of annuity computation, then up to three dates for estimates, each with the sick leave hours expected on that date.
Items 3 to 8: leave and service history
Emergency paid leave under ARPA (absence code 077) between 3/11/2021 and 9/30/2021, any transfer to FERS, survivor annuity, part-time service, temporary appointments and refunds of retirement contributions.
Items 9 to 12: health, life, dental and vision
FEHB plan name and enrollment code, FEGLI Basic and Options A, B and C with elections at age 65, and FEDVIP dental and vision plans.
Items 13 to 15: military and taxes
Active military service and any military deposit, retired military pay and whether it will be waived, and federal tax filing status and exemptions.
Remarks and General Instructions
A Remarks area and a note on page 3, then General Instructions on pages 4 and 5 that describe each retirement type and each item.
How to complete GSA Form 2828
- 1
Fill in the header
Enter your name, the date of your request, office symbol and phone number, and check your retirement system.
- 2
Pick the computation type
Check the type of estimate in item 1. Page 4 of the instructions describes each type.
- 3
Give the estimate dates
Enter up to three dates in item 2 with the sick leave hours on each. The form says dates for immediate annuity estimates should not be projected more than five years.
- 4
Answer the service questions
Complete items 3 to 8 with dates and agencies where asked, and attach a copy of the RI36-23 statement if you made a deposit or redeposit.
- 5
Choose coverage to carry over
In items 9 to 12, give the plans and elections you want to continue into retirement. Items 13 to 15 cover military service and tax withholding.
- 6
Add remarks and attachments
Use the Remarks area as needed. The note on page 3 says FERS employees asking for a date before age 62, and CSRS-Offset employees, should submit their most recent Social Security statement.
Why fill Form GSA2828 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the GSA, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes and what the form says
Where it goes
The PDF prints no filing address or office to send it to, and no Privacy Act notice or burden statement.
An estimate only
The form says the calculation that results from this information is only an estimate, and the actual annuity will be determined by the U.S. Office of Personnel Management.
Attachments the form names
A copy of the Civil Service Deposit Account Statement (RI36-23) for a deposit or redeposit, and the most recent Social Security statement for FERS dates before age 62 or CSRS-Offset.
Authority
GSA's page lists HRM 5440.6 as the authority or regulation and 07/2021 as the current revision date.
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SF3116
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GSA5050
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Who fills out GSA Form 2828?
The General Instructions ask the requester to give a name, office symbol and a phone number where they may be reached during office hours.
Official sources and the blank
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Questions about Form GSA2828
Who issues GSA Form 2828?
The footer names the General Services Administration and reads GSA 2828 (REV. 7/2021). GSA hosts it in its forms library, and its page lists HRM 5440.6 as the authority.
Is the result my actual annuity?
No. The form says the calculation is only an estimate and that the actual annuity will be determined by the U.S. Office of Personnel Management.
How many dates can I ask for?
Item 2 has room for three dates, each with the sick leave hours on that date. The form says dates for immediate annuity estimates should not be projected more than five years.
What should I attach?
The form asks for a copy of the Civil Service Deposit Account Statement (RI36-23) if you made a deposit or redeposit, and the most recent Social Security statement from FERS employees asking for a date before age 62 and from CSRS-Offset employees.
What is the ARPA question in item 3?
It asks whether you used emergency paid leave under the American Rescue Plan Act (ARPA), absence code 077, between 3/11/2021 and 9/30/2021, and if so, the number of hours.
Does GSA Form 2828 cover phased retirement?
Yes. Phased retirement is one of the computation types listed in item 1, with optional, disability, deferred, early optional or discontinued service, postponed annuity and MRA + 10.