FOIA
NOTICE OF APPROVAL OF DISABILITY RETIREMENT APPLICATION - MAKSYMIEC, MYROSLAW ANDREW
Document Type:
Keywords:
Collection:
Document Number (FOIA) /ESDN (CREST):
0001517111
Release Decision:
RIFPUB
Original Classification:
U
Document Page Count:
2
Document Creation Date:
June 22, 2015
Document Release Date:
August 26, 2008
Sequence Number:
Case Number:
F-2008-00615
Publication Date:
July 30, 1971
File:
| Attachment | Size |
|---|---|
 DOC_0001517111.pdf | 108.73 KB |
Body:
APPROVED FOR
RELEASE DATE:
11-Aug-2008
UNITED STATES CIVIL SERVICE COMMISSION
1 07 27-71
Bureau of Retirement, Insurance, and Occupational Health
Washington D C :20415 - l (I sb
NOTICE OF APPROVAL OF DISABILITY RETIREMENT APPLICATION
ew.v
DC 20505
Stop 64
L
-)Wasfsa:
The applicant for disability retirement identified below has been found totally disabled for useful and
efficient service in his position:
NAME (LAST) (FIRST) (MIDDLE)
DATE OF BIRTH
04-30-17
CLAIM NUMBER
CSA-1 30
DEPARTMENT OR AGENCY AND LOCATION (IF DIFFERENT THAN THAT SHOWN IN ADDRESS ABOVE)
POSITION
REMARKS
r--
.
This employee should now be separated in accordance with the procedure outlined in Federal Personnel
Manual Supplement 831-1 or similar instructions issued by your agency. Please?forwcrd the applicant's
Final Individual Retirement Record (SF 2806) as soon as possible. In addition, please observe the follow
inch , nstrizctions:
1. UNDER "REMARKS" -IN-THE SERVICE-HISTORY-'RECORD-OF-THE# FINAL
FORM 2806, GIVE DATE PAY CEASED.
2 ,ATT-ACH_,0NE COPY OF THISIEGJI T. ,T,,F - 806 FORWARDED
3. IF EMPLOYEE IS INSURED UNDER THE FEDERAL EMPLOYEES GROUP
.1s,ZF I TSTtJ.RAI~j,CrE RQ , Al~ui? UBTHE.; QRZQiINAL OF COMPLETED
AGENCY" ~ERTIFICATIO C3F "IM 1 NGE-" STATUS (SF 56) WITH THE
FINAL INDIVIDUAL RETIREMENT RECORD UNLESS THE EMPLOYEE
VFITSHES ''1'O =G"0 1VER`I''' T oAH' D'1PV1~Fy~Ti I P(? trICY ? POX
4. IF EMPLOYEE IS ENROLLED UNDER THE FEDERAL EMPLOYEES HEALTH
BENEFITS PROGRAM, AND APPARENTLY IS ELIGIBLE TO CONTINUE
HEALTH BENEFITS ENROLLMENT AS A RETIRED EMPLOYEE, PLEASE
WII THE FINAL INDIVIDUAL RETIREMENT RECORD:
SUBMI
7 PT
All triplicate copies of Health Benefits Registration Forms (SF 2809)
t~n~..,,..? ,- ~~:~s.;~mc~?ariylam~d~ea~~deEta:~esnltach~d;sth~r~o:~.
Q1uadf lieate*'cop r of Notice of Change in Health Benefits Enrollment
(SF 2810) transferring enrollment to the Civil Service Retirement
System.
S. IF FOR ANY REASON THE FINAL FORM 2806 CANNOT BE FORWARDED
WITHIN 10 DAYS, PLEASE FURNISH PROMPTLY THE INFORMATION RE-
QUESTED ON THE REVERSE SIDE OF DUPLICATE OF THIS LETTER.
B R 14648
(OVER) November 1969
F
United States Civil Service Commission
Bureau of Retirement, Insurance, and Occupational Health
Claims Division
Washington, D.C. 20415
L.
The requested information is furnished below as indicated by checked box:
Final Form 2808 forwarded to the Civil Service Commission:
Form, 2806 cannot be forwarded within 10 days because the employee is still on
leave with pay. The last day of pay will be
[] Form 2806 cannot be forwarded now because:
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