Form Ds 5026 PDF Details

Navigating the complexities of retirement benefits and earnings reporting can be a challenging task for retirees under the Federal Employees Retirement System (FERS). The DS 5026 form plays a crucial role in this scenario. This form, known as the FSPS Annuity Supplement Earnings Report, is designed to ensure that the annuity supplements of retirees are adjusted according to their post-retirement earnings. The FSPS annuity supplement is subject to an earnings test comparable to that used for Social Security benefits, initiating once a retiree reaches their Minimum Retirement Age (MRA). The earnings test adheres to the guidelines detailed in 5 U.S.C. Section 8421a, with the annual exempt amount and reduction rate of the supplement based on earnings exceeding this amount clearly outlined. Notably, the adjustment of benefits – whether a reduction, termination, or reinstatement – takes effect from the first day of the year following the reported income year. The form also specifies which types of income should be reported and provides a contact avenue for retirees who may have questions regarding their eligibility or the reporting process. Submission requirements emphasize the importance of timely and accurate completion to avoid potential termination of the annuity supplement. Through clear instructions and structured guidance, the DS 5026 form serves as an essential tool for managing the intricate balance between retirement benefits and post-retirement earnings.

Form NameForm Ds 5026
Form Length3 pages
Fillable fields0
Avg. time to fill out45 sec
Other namesfsps report online, 2002 787 medical capability edit, ds 5026, fsps annuitant wage report form

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1.The annuity supplement part of your FSPS is subject to an earnings test that begins after a retiree reaches the Minimum Retirement Age (MRA-see the chart below). The earnings test is similar to the one applied to Social Security benefits and uses the same annual exempt amount, as required by law in 5 U.S.C.

Section 8421a. The exempt amount changes from year to year and can be found at Your annuity supplement will be reduced $1.00 for every $2.00 by which your calendar year earnings exceed

the exempt amount. The reduction, termination or reinstatement of benefits will become effective January 1st of the year following the year of income reported. Refer to the chart below to find your MRA based on your year of birth.

If you were born…

Your MRA is…


Before 1948


55 years













55 years and 2 month





55 years and 4 months









55 years and 6 months





55 years and 8 months









55 years and 10 months





56 years









56 years and 2 months





56 years and 4 months









56 years and 6 months





56 years and 8 months









56 years and 10 months



1970 or later


57 years







2.Refer to the chart on the next page to see which types of income are reportable for the purpose of the earnings test. Please do not include pre-retirement salary or post-retirement annuity payments. If you have questions, please telephone the HR Service Center at 866-300-7419 Monday through Friday between 8:00 AM and 5:00 PM, Eastern Time.

3.In order for the Department of State to apply the earnings test to your annuity supplement, you must submit this form by January 10, 2014, starting the year after you reach your MRA. Submit the form even if you had no earnings for that previous year. Your annuity supplement will be terminated if the

FSPS Annuity Supplement Report is not received on time to establish your eligibility.

4.Please provide clear and legible information. Sign and send the form by one of the following methods:

Mailing Address



Department of State, HR Service


Center, Annuitant Services,



1999 Dyess Avenue, Building E,



Charleston, SC 29405



5.Retain copies of evidence supporting your claimed earnings in the event you are required to furnish documentation of earnings.

How To Determine Which Income to Report

Include as earnings:

-All wages from employment covered by Social Security.

-Net Income from self-employment

-All cash pay for agricultural work, domestic

work in a private home, service not in the course of your employer’s trade of business.

-All pay, cash or non-cash, for work as a home worker for a non-profit organization, no matter the amount. (The Social Security $100.00 tax does not apply.)

-All pay for work not covered by Social Security, if the work is done in the United States, including pay for:

Family employment

Work as a student, student nurse, intern, newspaper and magazine vendor,

Work for States or foreign governments or instrumentalities, and

Work covered by the Railroad Retirement Act.

Regardless of what income is called, if it is actually wages for services you performed or net earnings from self-employment you secured, it must be included in applying the earnings test.

Do not include as earnings:

-Pensions or annuities paid as retirement income, including your FSPS benefit or any benefits received as a survivor.

-Salary earned before retirement and/or lump- sum payment for annual leave upon retirement. This includes any separation incentives.

-Distributions from our Thrift Savings Plan or Individual Retirement Accounts.

-Unemployment compensation.

-Gifts, insurance proceeds, inheritances, scholarships, alimony, capital gains, net business losses, prize winnings.

-Payments-in-kind for domestic service in the employer’s private home, for agricultural

labor, for work not in the course of the employer’s trade or business, or the value of meals and lodging.

-Rentals from real estate that cannot be counted in earnings from self-employment because, for instance, you were not a real estate dealer.

-Interest and dividends not resulting from trade or business.

-Pay for military training or for jury duty.

-Payments by an employer which are reimbursement specifically for your travel expenses and which are so identified by the employer at the time of payment and/or reimbursement or allowance for moving expenses, if they are not counted as wages for Social Security purposes.

FSPS Annuity Supplement Report

Print Name Clearly

Year of Income

Employee ID or last four digits of SSN

Date Received by HRSC (completed by HRSC)

1.Is your annuity supplement currently reduced or terminated because you reported excess earnings last year? (Darken only one oval.)

OYes (Please skip directly to question 3.)

ONo (Please continue to question 2.)

2.Did you have any earnings after retirement and in the year entered above? (Darken only one oval.)

OYes (Please continue to question 3.)

ONo (Please sign and return document.)

3. What were your earnings for the year entered above?


Warning: Your earnings are subject to verification with the Social Security Administration’s earnings file. Any intentional false statement or willful misrepresentation is punishable by fine, imprisonment, or both (18 U.S.C. 1001).

Complete and return this form even if you had no earnings for the year indicated in the box above.

Failure to return this form may result in the termination of your annuity supplement.

Please do not include your salary before your date of retirement or any annuity payments.


Daytime Phone Number

E-mail address

Date: (mm/dd/yyyy)


Privacy Act Statement


The information is sought pursuant to the Foreign Service Act (22 U.S.C. § 3901 et seq. and


22 U.S.C. § 4071) and E.O. 9397, as amended. 31 U.S.C. § 7701 requires any person doing


business with the Federal government furnish a Social Security Number or tax identification




The information solicited on this form will be used to determine your eligibility to continue


receiving the annuity supplement and the amount of the supplement.


The information may be shared with national, state or local government, or the Social


Security Administration in order to determine benefits and issue benefits under their


programs, to obtain information necessary for determination or continuation of benefits


under this program or to report income for tax purposes. It may also be shared and verified,


as noted above with law enforcement agencies when they are investigating a violation or


potential violation of civil or criminal law. More information on the Routine Uses for the


system can found in the System of Records Notice, State-31, Human Resources Records.


The collection of this information is voluntary, however, failure to provide may result in


benefits being denied.

How to Edit Form Ds 5026 Online for Free

We were building our PDF editor with the prospect of making it as fast to use as it can be. Therefore the process of filling out the fsps report will likely to be simple carry out the following steps:

Step 1: The following page includes an orange button stating "Get Form Now". Hit it.

Step 2: At the moment you are on the document editing page. You may enhance and add content to the file, highlight words and phrases, cross or check specific words, insert images, put a signature on it, get rid of needless fields, or take them out altogether.

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part 1 to filling in 2002 form ssa physicians medical manage template

In the field Print Name Clearly, Year of Income, Employee ID or last four digits of, Date Received by HRSC completed by, Is your annuity supplement, year Darken only one oval, O Yes Please skip directly to, Did you have any earnings after, O Yes Please continue to question, Dollars Cents, Warning Your earnings are subject, and intentional false statement or write down the data that the program requests you to do.

stage 2 to filling out 2002 form ssa physicians medical manage template

Mention the main information in Signature, Email address, Daytime Phone Number, Date mmddyyyy, PURPOSE, Privacy Act Statement AUTHORITY, USES, and benefits being denied area.

Entering details in 2002 form ssa physicians medical manage template part 3

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Step 4: Ensure that you avoid possible problems by creating a minimum of a pair of copies of the file.

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