OPM FedFlex Payment Report By Agency Sum Controlled Unclassified Information (CUI) (XXXX) Org Plan Code FD  Premium W/H  Plan Code FH  Premium W/H   Total Participants/Premium W/H   XXXXXX   2    $105.12    1    $96.15    3/$201.27    Total:   2    $105.12    1    $96.15  *  3 / $201.27

* The grand total of participants may not equal the individual count of employees with FD plans plus the employees with FH plans. The inequality may result because some employees may participate in both plans and will be counted in the grand total of participants only once.

Selection Crieria : Year and Payperiod = 2006 - 06 and Fed Flex Plan = OPM Fed Flex Dependent Care Acct (FD) and OPM Fed Flex Health Care Acct (FH) and Separation Accession Type = NotSeparatedorAccessionthisPayPeriod

OPM FedFlex Payment Report By Agency Controlled Unclassified Information (CUI) (XXXXXX) SSNO Name Ret Coverage Plan Code FD  Premium W/H  Plan Code FH  Premium W/H   Total Premium W/H   999-99-9999  HARLEY , JOE H  (K) FERS AND FICA   FD   $16.66        $16.66   999-99-9999  HARLEY , SUE K  (K) FERS AND FICA        FH   $96.15   $96.15   999-99-9999  SMITH , JOHN A  (K) FERS AND FICA   FD   $88.46        $88.46    Total:   2    $105.12    1    $96.15  *  3 / $201.27

* The Grand total of participants may not equal the individual count of employees with FD plans plus the employees with FH plans. The inequality may result because some employees may participate in both plans and will be counted in the grand total of participants only once.

Selection Crieria : Year and Payperiod = 2006 - 06 and Fed Flex Plan = FD and Separation Accession Type = NotSeparatedorAccessionthisPayPeriod