FBR Intake Form

FEDERAL BENEFITS REPORT INTAKE FORM
(ADVISOR USE ONLY)

Submit your requests for a federal benefits analysis report below. Each request must be made individually for each prospect. This is intended to be used with the federal leads that are purchased through Total Advisor. Please keep in mind the following guidelines when making your requests:

Before putting in the request for the report, call the prospect first to verify their personal and financial data so that we can create the most accurate benefits report possible.
For agents with scheduled appointments, allow up to a 72 hour turnaround
Maximum (5) benefits analysis reports will be provided at NO COST.
For agents who do not have scheduled appointments, allow to the end of the business week for it to be completed. Requests of this nature submitted on a Friday, will be completed the following week.
****The information requested below helps us create a simplified version of the federal benefits report. IF you are looking for a more detailed version of the report that requires more information than what's being asked below, then you will be required to purchase the software that allows for more customization.
In addition, your first (5) benefit analysis reports are provided at NO COST. Thereafter each request will cost $20 per benefits analysis report request. To run your own reports, you can purchase the software by clicking the following link. Click Here to for details on how you can access the Federal Benefits Software immediately.

Federal Benefits Report Request

* Indicates required field

Advisor Name *

First

Last

Advisor Phone Number *

Advisor Email *

Required Info

Have you spoken with and verified the data with the prospect by phone? *

Do You have a scheduled phone or in-person appointment with the prospect? *

If you answered yes, what is the scheduled date? *

Client Name *

First

Last

Date of Birth *

Service Computation Date *

Retirement Goal Date *

FERS or CSRS *

FERS CSRS

Client Address *

Line 1

Line 2

City

State

Zip Code

Country

Annual Salary *

Additional Info

TSP Balance *

TSP Percent Contributing *

Specify the type of allocation funds that are in the TSP below *

Monthly social security income (Enter EXACT dollar amount/monthly below) *

If you submitted a monthly social security amount above, enter EXACT age for social security income to start below *

Federal Employee's Group Life Insurance Info (FEGLI)

Type of FEGLI Options: (click all that apply) *

Option A: $10k additional insurance Option B: Up to 5 times salary (write how many times in the box below) Option C: Family, Up to 5 times salary Spouse $5,000/Children $2,500 (write how many times in the box below)

FEGL Options Info (If you checked off Option B or C above, make sure to complete) *

Tobacco User? *

Yes No

Other Employee Type (Select ONLY if they are one of the following) *

Submit

FEDERAL BENEFITS REPORT INTAKE FORM(ADVISOR USE ONLY)

Federal Benefits Report Request

Required Info

Additional Info

FEDERAL BENEFITS REPORT INTAKE FORM
(ADVISOR USE ONLY)