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SURVIVOR BENEFIT PLAN (SBP) FORMER SPOUSE OMB …
USPHS. b. (X one) Active. ReserveNational Guard 4. IS MEMBER RETIRED? YES. NO 5. IF KNOWN, ENTER DATE OF MEMBER'S RETIREMENT (YYYYMMDD) SECTION II - FORMER SPOUSE IDENTIFICATION. 6a. FORMER SPOUSE NAME (as it appears on court order) (Last, First, Middle Initial) 6b.CURRENT NAME. 8. ADDRESS (Last, First, Middle Initial) 7. SSN or …
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