Federal Employee Benefit Analysis

Tell me a little about yourself to better help you.

Name*

First Last

DOB:*

Address:*

City State / Province / Region ZIP / Postal Code

Phone:*

Email:*

Best Time to Call:*

:

Marital Status:*

Married
Single
Divorced
Spouse Federal Employee

Spouse DOB:*

Spouse Name:*

First Last

Are you a Postal employee:

Yes

Hire Date:*

Sick Time*

Annual Time*

Let’s start understanding your government benefits.

Are You:*

Retired
CSRS
FERS
OFFSET
Special Group(Firefighter, Law Enforcement, Air Traffic, etc.)

Desired Retirement Date:*

Work Location:*

Salary:*

Part-time Service on or after 1986: (Dates)*

Military Service: (Dates)*

Breaks in Service: (Dates)*

FEHB in last five years?*

Yes

FEHB Type:*

Self
Self plus one
Family
Basic
Standard

Plan Name:*

Plan Premium:*

FEGLI?*

Yes

Option A*

Yes

Option B*

Option C Spouse:*

Option C Children:*

Disabled Dependent:*

Yes

TSP?

Yes

Contribution: %*

Dollar Amt:*

Traditional:*

Traditional

Balance:*

Roth*

Roth

Balance*

G:*

F:*

C:*

L:*

I:*

L20*

L30*

L40*

L50*

Is there anything else we need to consider that may affect or influence your retirement?

Social Security @ age 62:*

@ age 66 or 67:*

@ age 70:*

Spouse Social Security @ age 62:*

@ age 66 or 67:*

@ age 70:*

Private Life Insurance:*

Term
Whole

Premium Amount:*

Medicare:*

Yes

Medical Supplement:*

Yes

Premium Amount:*

Outside Retirement Savings:*

Roth IRA

Balance:*

Outside Retirement Savings:*

Traditional IRA

Balance*

What is your retirement monthly budget need:*

What are your retirement concerns?*

Income
Survivor Income Planning
Thrift Savings Plan
Medical Costs
FEGLI
Long Term Care