Blocks 1 to 8: employee information
Printed name, last 4 digits of SSN, office or division, duty location, title, series and grade, manager or supervisor, and the effective and ending dates of phased retirement.
GSA5050
Phased Retirement Time Limit Agreement
- Agency
- GSA
- Revision
- Rev. 9/2018
- Fillable fields
- 34
- Pages
- 3
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 5050: Phased Retirement Time Limit Agreement
GSA Form 5050, Phased Retirement Time Limit Agreement, is a three-page General Services Administration (GSA) form, printed as GSA 5050 9/2018. GSA hosts it in its forms library, and GSA's page lists HRM 9900.1 as its authority or regulation.
The form says that per GSA Phased Retirement Guidance and Procedures (HRM 9900.1), this agreement is required for each period of phased retirement. It sets the terms and time limits of the employee's phased employment for a maximum period of two years, which is a condition of approval. The form notes that an employee may only enter phased retirement one time, and that with authorized management approval the current period may be extended before it expires.
The employee initials items A to L and signs, and the supervisor and an authorizing official sign below recommended and approved boxes. You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 5050
Items A and B: schedule and mentoring
A 50 percent tour of duty of no more than 20 hours per week or 40 hours per pay period, and at least 20 percent of the schedule spent on mentoring and training under an attached mentoring agreement.
Items C to E: pay and benefits
Service deposits and redeposits, no FERS annuity supplement during phased retirement, annual leave payment, FEHB and FEGLI premiums, and a possible delay before the first OPM annuity payment.
Items F to H: ending or changing status
Full retirement at any time without agency consent, a return to regular full-time employment with management approval, and a new appointment at another agency.
Items I to L: end of the term
Separation when the term in block 8 ends, deemed full retirement after 3 or more calendar days without employment, rescinding or changing the agreement, and an affirmation of eligibility.
Blocks 10 to 20: decisions and signatures
Agency comments, recommended and approved boxes, and printed names, signatures and dates for the employee, supervisor and authorizing official.
How to complete GSA Form 5050
- 1
Fill in employee information
Blocks 1 to 8 ask for the employee and supervisor details and the effective and ending dates of phased retirement.
- 2
Review and initial each item
Block 9 says to review and initial each item, A through L, before entering phased retirement.
- 3
Note the mentoring agreement
Item B refers to a mentoring agreement, agreed to with management and attached, covering at least 20 percent of the working schedule.
- 4
Employee signs
The employee prints a name, signs and dates in blocks 12 to 14. Item L says initialing and signing affirms having read and meeting the eligibility requirements.
- 5
Supervisor and authorizing official sign
Blocks 15 to 20 hold the supervisor's and the authorizing official's printed names, signatures and dates.
- 6
Record the decision
Blocks 10 and 11 mark the agreement recommended and approved, YES or NO. The form says the reason for a disapproval is identified in the agency comments.
Why fill Form GSA5050 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
Terms and what the form says
Where it goes
The PDF gives no filing address. It points to GSA Phased Retirement Guidance and Procedures (HRM 9900.1).
Length of the agreement
A maximum period of two years. The form says the current period may be extended with authorized management approval before the expiration date.
Leaving phased retirement
Item F says the employee submits an expiration agreement and notifies management at least 30 days before the intended separation date. Item G also uses an expiration agreement for a return to full-time work.
Deposits and redeposits
Item C describes an election to pay in full within 30 days of OPM's receipt of the phased retirement application, or to receive a permanent actuarial annuity reduction.
Moving to another agency
Item H says the new agency's authorizing official approves in writing and the working percentage may not change. If the new agency does not approve, phased retirement terminates.
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Who completes GSA Form 5050?
The form has places for the employee, the supervisor and an authorizing official.
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Questions about Form GSA5050
Who issues GSA Form 5050?
The footer reads GENERAL SERVICES ADMINISTRATION and GSA 5050 9/2018. GSA hosts it in its forms library, and its page lists HRM 9900.1 as the authority or regulation.
How long can phased retirement last under this agreement?
The form sets a maximum period of two years of phased employment, and says the current period may be extended with authorized management approval before the expiration date.
How many hours does the form describe?
Item A describes a 50 percent tour of duty, not more than 20 hours per week or 40 hours per pay period, except in rare and exceptional emergency circumstances as management directs.
Is mentoring part of the agreement?
Yes. Item B says mentoring is an essential element of phased retirement, with at least 20 percent of the working schedule spent on mentoring and training under an attached mentoring agreement.
What happens when the agreement ends?
Item I says the employee will be separated when the agreed terms end, as a voluntary action based on the written agreement, and will then be deemed to have elected full retirement.
Can someone enter phased retirement more than once?
The form notes that an employee may only enter phased retirement one time, though the current period may be extended before it expires.