Items 1 to 8: employee information
Employee printed name, last 4 digits of SSN, office/division, duty location, title, series and grade, name of manager/supervisor, and the effective and ending dates of phased retirement.
GSA5052
Phased Retirement Expiration Agreement
- Agency
- GSA
- Revision
- Rev. 9/2018
- Fillable fields
- 27
- Pages
- 3
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 5052: Phased Retirement Expiration Agreement
GSA Form 5052, Phased Retirement Expiration Agreement, is a General Services Administration form, edition 9/2018, listed in GSA's forms library. The form says that, per GSA Phased Retirement Guidance and Procedures (HRM 9900.1), the agreement is required to officially document the expiration of a period of phased employment/phased retirement.
It is an internal GSA personnel form. The employee in phased retirement fills in the employee information, initials the items that apply and signs. The supervisor and an authorizing official then sign and mark it recommended and approved, or not. The form lists three ways the status ends: a return to regular employment status, a transfer to another agency, or full retirement status, and it points to a part of SF 3116 for each.
You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 5052
Item 9 (A) and (B): the agreement and a return to regular status
(A) completing, signing and submitting this agreement to the manager. (B) completing and signing SF 3116, Part 2A. The form says a request to return to regular employment status is approved by GSA Management.
Item 9 (C) and (D): transfer to another agency
(C) continuing phased employment/phased retirement status at a new Federal agency with SF 3116, Part 3A and that agency's written consent. (D) ending the status on transfer with SF 3116, Part 3B.
Item 9 (E): full retirement
The form says that if the employee is separated from employment and has not been employed within 3 calendar days or more, they will be deemed to have elected full retirement.
Items 10 to 20: comments, decision and signatures
Agency comments, Recommended and Approved yes or no boxes, and printed names, signatures and dates for the employee, supervisor and authorizing official. The form says a reason for disapproval is given in the agency comments.
The form has three pages.
How to complete GSA Form 5052
- 1
Fill in items 1 to 8
Enter the employee details, the name of the manager or supervisor, and the effective and ending dates of phased retirement.
- 2
Initial the items that apply
Item 9 asks the employee to review and initial each item. The form says initialing confirms understanding, acceptance and completion of the items as applicable.
- 3
Complete the matching SF 3116 part
The form names Part 2A for a return to regular employment status, Part 3A to continue phased status at another agency, and Part 3B to end it on transfer.
- 4
Send the SF 3116 part by email
The form says to submit the completed, signed SF 3116 part to the GSA Benefits and Retirements Team at [email protected].
- 5
Sign and route for approval
The employee signs and dates items 12 to 14 and submits the agreement to the manager. The supervisor and the authorizing official then complete items 10, 11 and 15 to 20.
Why fill Form GSA5052 on indox
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Routing and what the form says
Where it goes
The form says to submit the agreement to the employee's manager, and the signed SF 3116 part to the GSA Benefits and Retirements Team at [email protected].
What OHRM does
The form says OHRM files the SF 3116 in the employee's eOPF. For a return to regular employment, it forwards a copy of Part 2A to OPM within 15 days of the election, and OPM terminates the phased retirement annuity.
Moving to another agency
The form says a new appointment at another agency, with that agency's approval for phased retirement, may occur before the current agreement expires or within 3 calendar days after it expires, and the 50% working percentage may not change.
Appeals
The form says denial of an application for phased retirement is not an appealable adverse action under Title 5, U.S.C. Chapter 75, but it may be appealable under administrative grievance procedures.
Authority
The form and GSA's page cite GSA Phased Retirement Guidance and Procedures, HRM 9900.1. The PDF prints no OMB number or Privacy Act notice.
Related forms
Who fills out GSA Form 5052?
The form is completed and signed inside GSA. These are the people and offices it names.
Official sources and the blank
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Questions about Form GSA5052
Who issues GSA Form 5052?
The form is printed as a General Services Administration form, GSA 5052 9/2018. GSA's page lists HRM 9900.1 as its authority, and GSA hosts it in its forms library.
What are the three options on GSA Form 5052?
The form lists (1) Return to Regular Employment Status, (2) Transfer to Another Agency and (3) Enter Full Retirement Status. The employee initials the items that apply in item 9.
Which SF 3116 part goes with each option?
The form names SF 3116, Part 2A for a return to regular employment status, Part 3A to continue phased status at a new Federal agency, and Part 3B to end phased status on transfer.
What if I separate and am not employed again within 3 calendar days?
The form says that if you are separated from employment and have not been employed within 3 calendar days or more, you will be deemed to have elected full retirement.
Can a denial of phased retirement be appealed?
The form says denial of an application for phased retirement is not an appealable adverse action under Title 5, U.S.C. Chapter 75, but it may be appealable under administrative grievance procedures.
Where is a No answer explained?
Items 10 and 11 have Recommended and Approved boxes. The form says the reason for disapproval is identified in the agency comments on page 3.