Payroll and Benefits Questionnaire

1. Federal Employee Health Benefit (FEHB). Your FEHB will be restored to your
previous election prior to separation.

Note: If you were not enrolled in FEHB prior to your separation date and/or you were not
within your 60-day initial opportunity to enroll, you are not able to participate in FEHB. If
you experienced a QLE that would allow you to change/cancel your election, or you are
covered under another insurance policy submit an updated SF-2809 to
ogden.benefits.section@irs.gov.

2. Federal Employees Group Life Insurance (FEGLI). Your FEGLI will be restored to
your previous election prior to separation.

3. Federal Employees Dental and Vision Insurance Program (FEDVIP). Your
FEDVIP will be restored to your previous election prior to separation.

4. Separation in Lieu of Reinstatement. If you choose to remain separated in lieu of
returning to the IRS, you may submit a resignation to separation@irs.gov.

5. Outside Employment. Contact the Employee Resource Center (ERC) at 1-866-743-
5748, option 1. The IRWorks team will notify your manager of your intent to accept
outside employment.

6. Unemployment. Contact your state/local agency to discuss a potential repayment of
unemployment payments received during the time you were separated.

7. Lump Sum Payment of Annual Leave. If you received a lump sum payment for
your annual leave, you may request a debt be established to buy back your annual
leave or you may keep the lump sum payment without buying back your annual leave
balance. If you are requesting to buy back/retore your annual leave, please contact the
ERC for assistance with submitting an IRWorks ticket.If you did not receive a lump sum
payment for your annual leave, your leave balance will be restored.

8. Sick Leave. Your sick leave balance will be restored to the balance you had prior to
separation unless a debt was established for negative sick leave. Negative sick leave
debts that were billed will be worked on case-by-case basis. Please contact the
Employee Resource Center for assistance with submitting an IRWorks ticket.

9. Thrift Savings Plan (TSP). Verify your TSP contributions in the Employee Personal
Page (EPP). Changes to your TSP contributions may be made in EPP.

10. Direct Deposit. Verify that your banking information is correct in the EPP.

11. Within-Grade/Career Ladder Promotion. Your account will be automatically
reviewed for any missing Within-Grade Increase and/or Career Ladder Promotion.

12. Union Dues. If applicable, will be reinstated to match what you were contributing
prior to separation.