Help Your Agent Prepare

A few details from your pay stub and LES help your agent walk in ready to answer your questions: no cost, no obligation.

Your Benefits Details

Everything below is optional except your name and email: share what you have handy, and we'll fill in the rest together on your call.

First Name

Last Name

Email Address

Cell Phone (optional)

Personal Info

Date of Birth

Gender

Street Address

City

State

Zip

Spouse Name

Spouse Date of Birth

Spouse Gender

Children / Dependent Ages

Employment & Benefits

Most of this is on your most recent pay stub or Leave and Earnings Statement (LES).

Current Employer / Agency

Current Position

Current Salary

Target Retirement Date

Target Retirement Age (if you don't have a date yet)

Military Buyback

Time Purchased

Military / VA / Disability Pension (annual amount, if any)

Service Computation Date (SCD)

Interruptions in Federal Employment

Other Credited Federal Time (for FERS purposes)

Sick Leave Balance

Unit

Annual Leave Balance

Unit

FEHB Premium (per pay period)

FEGLI Code

TSP Balance

TSP Contribution %

Roth Balance

Roth Contribution %

Anything Else

Other Assets or Income Sources

Any Family Situations We Should Know About?

Notes / Questions

Federal Benefits Exchange respects your privacy and will never sell your information. View our Privacy Policy.

Help Your Agent Prepare

Your Benefits Details

Personal Info

Employment & Benefits

Anything Else

Thanks: We'll Be In Touch!