Work Years And Personnel Costs Report-Cost Of Employees Benefits {OPM 1351B}

1. Agency Name WORK YEARS AND PERSONNEL COSTS REPORT COST OF EMPLOYEES BENEFITS FISCAL YEAR 2. Agency Code CODE 300 301 Total Cost of Benefits Health Insurance ITEM OMB OBJECT CLASS 12.1 12.1 COST (Thousands) For Agency Edit Check: COST AS PERCENT OF BASIC PAYROLL - Federal Employees Health Benefits Act - Other 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 400 Life Insurance ­ Federal Employees Group Life Insurance (FEGLI) Retirement - Civil Service Retirement System (CSRS) - Federal Employees Retirement System (FERS) Basic Benefit - Federal Employees Thrift Plan (FERS) - Other Retirement Systems (specify) Federal Insurance Contributions Act Taxes (OASDHI) Federal Employees Compensation Act (FECA) Payments to Department of Labor Uniform Allowances Overseas Allowances (including overseas cost of living allowance (COLA)) Non-Foreign COLA Retention Allowance Recruitment Bonus Relocation Bonus Other Benefits included in Object Class 12.1 Total Separation Pay (includes severance pay and separation incentive) - Severance Pay - Separation Incentive (i.e., "Buyout Bonus") Total Benefits Plus Separation Pay (Sum of Codes 300 and 400) 12.1 & 13.0 OPM Form 1351-B (Re v. 11/97) American LegalNet, Inc. www.FormsWorkFlow.com 12.1 12.1 12.1 12.1 12.1 12.1 12.1 12.1 12.1 12.1 12.1 12.1 12.1 12.1 12.1 13.0