Transcription of Application for Death Benefits - OPM.gov
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Application for Death Benefits - OPM.gov
Form approved: Application for Death Benefits OMB number 3206-0172 Federal Employees Retirement System Federal Employees Retirement System This Application is for use by persons applying for Benefits which may be payable under the Federal Employees Retirement System (FERS) because of the Death of an employee, former employee, or retiree who was covered by FERS at the time of his/her Death or separation from Federal service. You should have received an informational pamphlet entitled, Applying for Death Benefits Under the Federal Employees Retirement System, SF 3114 with this Application . If you did not receive the pamphlet and the deceased was a Federal employee at the time of his/her Death , you should get a copy from the deceased's employing agency.
Form Approved Application for Death Benefits Federal Employees Retirement System Federal Employees Retirement System System: : Office of Personnel Management
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