Standard Form 2805 (SF 2805): Request for Recovery of Debt Due the United States

Debtor and survivor identification

Name of the annuitant or former employee and other names used, retirement system (CSRS or FERS), Social Security Number, date of birth and retirement claim number (CSA), and the same details for any survivor (CSF).

Description of Debt

Name and address for payment, date service terminated, date the claim accrued, amount of debt, amount of each installment, appropriation or fund to credit, disbursing officer, whether additional interest will accrue, and the reason for the debt.

Due Process certification

The agency certifies the debt and the procedures followed, and agrees, if ordered by a competent administrative or judicial authority, to reimburse OPM or repay the debtor within 15 days of the date of the order.

Due process checklist

The date of the demand letter and of the notice of intent to offset retirement benefits, and boxes for a judgment for restitution, the debtor's acknowledgment, consent or no response, and a requested review or hearing and its result.

OPM Report of Action

Results a to g: the account is available for immediate set-off, the request is filed for possible future action for one of several reasons, OPM cannot identify the debtor from the data furnished, or Other.

The single page has these blocks.

1. 1

   Identify the debtor

   Enter the annuitant's or former employee's name, retirement system, Social Security Number, date of birth and retirement claim number, and the survivor's details if applicable.

2. 2

   Describe the debt

   Give the amount of debt, the amount of each installment, the dates service terminated and the claim accrued, where payment goes, whether additional interest will accrue, and the reason for the debt.

3. 3

   Check the due process statements

   Check all statements that apply. The form says the creditor agency MUST send the notice of intent to offset retirement benefits, even if there is a judgment for restitution, and that notice is provided before recovery is requested.

4. 4

   Attach the supporting copies

   Where checked, the form says a judgment for restitution, the debtor's acknowledgment of the debt, or the debtor's consent to collection from retirement benefits is attached.

5. 5

   Sign the certification

   The agency official making the certification signs and dates it and adds a title, telephone number and fax number.

6. 6

   OPM reports its action

   OPM checks a result and signs. For result f, the form says OPM will make another attempt after the agency enters the missing items and returns all copies.

• 

  SF2806

  Individual Retirement Record - Civil Service Retirement System (CSRS)

  242 fields, 1 page

• 

  SF2802

  Application for Refund of Retirement Deductions - CSRS

  131 fields, 8 pages

• 

  SF2801

  Application for Immediate Retirement CSRS

  454 fields, 21 pages

• The creditor agency

  The agency owed the debt fills in the identifying details of the annuitant or former employee, the Description of Debt and the due process statements that apply.

• The certifying agency official

  An agency official signs and dates the certification and adds a title, telephone number and fax number.

• The Office of Personnel Management

  An authorized OPM official completes the Report of Action on Request for Recovery by checking one of results a to g, then signs and dates it.

• The debtor, named on the form

  The annuitant or former employee from whom collection is sought, and any survivor, are identified on the form. The due process checklist records notices sent to the debtor and the debtor's response.

The form prints blocks for two offices. It has no block for the debtor to sign.

• Official GSA form page

  The agency’s own page for Form SF2805.

• Blank PDF

  The official blank form, to print or fill by hand.

  Download blank PDF

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