For a copy of the PA 21-BI, click here.
On line 1, enter the date for the first monthly payment period in the fiscal year.
On the next lines, enter the dates for the rest of the payment periods.
If SBP is discontinued during the fiscal year, enter "Disc." and the end date.
Enter the source of the income used to decide the SBP payment amount.
Use a separate line for each source.
Complete only if anticipated rather than actual income was used to calculate the SBP payment.
Enter the amount of income expected from each source.
Enter the allowable deductions.
Enter the expected net income from each source.
NOTE: Do not make an entry if there is only one source.
Enter the actual total net income expected from all sources.
In the field opposite the total expected net income, enter each SBP payment amount or amount that would have been paid if an overpayment were not being satisfied.
Enter "0" for each payment period there was no SBP payment for any reason.
Enter the actual gross income.
Enter the allowable deductions.
Enter the actual net income from each source.
NOTE: Do not make an entry if there is only one source.
Enter the actual total net income from all sources.
Issued October 2, 2012, replacing March 16, 2012