Edit, Download, and Sign the Federal Employees Retirement System Application for Death Benefits
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How do I fill this out?
Complete the application in clear type or hand print using black ink. Ensure all sections are filled out accurately and all required attachments are included. Refer to detailed instructions for specific sections.
How to fill out the Federal Employees Retirement System Application for Death Benefits?
1
Type or hand-print clearly in black ink.
2
Provide all necessary information accurately.
3
Attach copies of required documents.
4
Send the completed application to the appropriate address.
5
Use the provided checklist to ensure completeness.
Who needs the Federal Employees Retirement System Application for Death Benefits?
1
A spouse of the deceased employee, former employee, or retiree.
2
A designated beneficiary listed in the records of the deceased.
3
Parents of the deceased if they are listed as beneficiaries.
4
An executor or administrator of the deceased person's estate.
5
A guardian or caretaker of any dependent children of the deceased.
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What are the instructions for submitting this form?
For employees at the time of death: send the completed application to the personnel office where the deceased was last employed. For former employees or retirees: send the application to OPM, FERS, P.O. Box 45, Boyers, PA 16017-0045. If your address changes before receiving your claim number, notify OPM with your name, date of birth, Social Security Number, and the deceased's information. Advice: Double-check to ensure all sections are complete and required documents are attached to avoid delays in processing.
What is the purpose of this form?
The FERS Application for Death Benefits is used by eligible beneficiaries to claim death benefits. This form ensures that persons such as spouses, designated beneficiaries, parents, and guardians receive the financial support due to the loss of a loved one covered under FERS. Accurate completion and submission of this form facilitate timely and proper distribution of benefits.
Tell me about this form and its components and fields line-by-line.
- 1. Section A - Information About the Deceased: Includes the deceased's personal details, CSA number, and information regarding any benefits from OWCP.
- 2. Section B - Information About the Applicant: Requires details of the person applying for benefits, including beneficiary designation, if applicable.
- 3. Section C - Information About the Deceased Person's Spouse: Details of the marriage, including certification and any prior marriages.
- 4. Section E - Information About the Deceased Person's Dependent Children: List of all surviving unmarried dependent children and their birth certificates.
- 5. Section F - Information About Other Heirs: Details about other relatives who may be eligible to inherit.
- 6. Section G - Information About the Deceased Person's Estate: Information about the executor or administrator of the estate.
- 7. Section H - Active Military Service: Details about the deceased's military service, if applicable, and any deposits for credit.
- 8. Section I - Payment Instructions: Instructions for how the benefits will be paid, including Direct Deposit options.
- 9. Section K - Applicant's Checklist: To ensure all necessary documentation is attached.
- 10. SF 3104A: Supplement form for surviving spouses if the deceased was a retiree.
- 11. SF 3104B: Form for documentation and elections when the deceased was an employee.
- 12. Privacy Act Statement: Information on how the provided data will be used and shared.
- 13. Public Burden Statement: Estimate of the time required to complete the form.
What happens if I fail to submit this form?
Failure to submit the form may result in delays or denial of benefits.
- Delay in Benefits: Not submitting in time could delay financial support for the survivors.
- Loss of Entitlement: Failure to provide required documentation may result in losing entitled benefits.
How do I know when to use this form?
- 1. Death of an Employee: Submit when a federal employee covered by FERS dies.
- 2. Death of a Retiree: Submit when a retired federal employee under FERS dies.
- 3. Death of a Former Employee: Submit when a former federal employee, not yet receiving retirement benefits, dies.
- 4. Dependent Children: Apply on behalf of the deceased's dependent children.
- 5. Designated Beneficiary: If you are named as a beneficiary in the records of the deceased.
Frequently Asked Questions
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What should I do if I need more space to answer?
Attach an additional sheet of paper with your name, date of birth, and Social Security Number at the top.
Where do I send the completed application?
Mail it to the address provided in the instructions specific to your situation.
How do I know if I need this form?
If you are an eligible beneficiary under FERS, you need this form.
What information is required for this form?
You will need personal details, Social Security numbers, and supporting documentation.
How can I verify my submission is complete?
Use the provided checklist in Section K of the application.
Can I get payments electronically?
Yes, Direct Deposit and Direct Express debit card options are available.
What should I do if my address changes?
Notify OPM with updated details including your and the deceased's information.
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