Designation of a Recipient of the Federal Employees Compensation Act Death Gratuity Payment under Section 1105 of Public Law 110-181 (Section 8102a). Beneficiary - Federal Employees' Group Life Insurance Program OPM Retirement Operations Center P.O. Standard Form 2823 is used by any Federal employee or retiree covered by the Federal Employees' Group Life Insurance (FEGLI) Program, or an assignee who owns an insured's coverage, to instruct the Office of Federal Employees' Group Life Insurance how to distribute the proceeds of the FEGLI coverage when the statutory order of precedence does not meet his or her needs. The SF 2808, if applicable, should be sent directly to OPM at the address on the . See examples 5 and 6 on the Back of Part 1. Designation of Beneficiary Forms This notice is a reminder to review your designation of beneficiary forms and update them as needed. Any changes to the process would be temporary. Get Civil Service Retirement System Form: SF-2823 Health Benefits Registration (FT/PT Only; Have 60 days from effective date of appointment to enroll) TSP-1. If you are satisfied with the order of precedence the law provides and you do not have a certified designation on file, you do not need to make a designation. Having trouble downloading PDF files or with the PDF editor. of attorney or other similar legal authority may. publication in the future. 3206-0136 Federal Employees' Group Life Insurance (FEGLI) Program Group Life Insurance Read instructions on the (DO NOT erase or cross-out. Employees must be enrolled in Basic Life in order to elect Optional Insurance. Evaluate the accuracy of the agency's estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used; 3. 2819 - Notice of Conversion Privilege. and services, go to If you want benefits paid to someone else or in a different order, you must designate a beneficiary. ATTN: Civilian Benefits Center However, it is a good practice to periodically take the time to review these forms, especially when you have a significant change in your life such as a marriage, birth of child, or a divorce. San Diego, CA 92145 PART 1-Original Important - the filing of this form, if valid, will completely cancel any Designation of Beneficiary you may have previously thefiled Federal under Employees' Group LifeInsurance Program. The AtHocbutton requires a government computer and a government Common Access Card (CAC) to enter site. The examples printed on the back of the first page of this form may be helpful to you in naming a beneficiary or canceling a prior designation of beneficiary. Boyers, PA 16017-0045, Federal Employees Retirement System (FERS) or 1.0. The cost of Basic Life Insurance is shared between the employee and the Government, you pay 2/3 of the total cost and the Government pays 1/3. 10/06/2020 at 8:45 am. Document Drafting Handbook Complete a CA-40 Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment. SF-2823 Designation of Beneficiary Federal Employees Group Life Insurance Program To obtain this form go to http://www.opm.gov/forms/pdf_fill/SF2823.pdf Download Adobe Reader Email Page Last Reviewed: 2017-08-17 Home Resources for Americans with Disabilities Citizens and Consumers A divorce does not invalidate a designation that names your former spouse as beneficiary; you must complete a new designation form. You should review your beneficiary designation whenever you have a significant change in your life, such as a marriage, divorce, or death. Many employees file a designation of beneficiary form and then never think about it again. Read the instructions on the form carefully since they are different from other beneficiary forms. Federal Employee Group Life Insurance (FEGLI) Career/Career Conditional Appointment/Reinstatement | Career/Career Conditional Transfer | Career/Career Conditional Conversion | Competitive Service Temporary NTE 1 year or less | Excepted Service: Pathway Temporary Intern or Career Intern | Excepted Service Temporary NTE 1 yr or less | Term Appointment | Excepted Service Permanent/Conditional | Excepted Service - Pathway Recent Graduates | Pre-Appointment Forms | EOD Forms | Factsheets and Other Handouts, (employee new to Government service or being reinstated), (current USGS employee, but on another type of appointment), Go to @theCore's A-Z Index and select DOI - Access Card (Smart Card) for more information, (Sch. Benefits for life insurance, retirement, Thrift Savings Plan, and unpaid compensation are automatically distributed in the following order of precedence: An exception to the order of precedence is for Federal Employees Group Life Insurance (FEGLI). If you need more space when completing this form, see "What if I need more room?" The information collection (OMB No. See EOD Forms section below. number; If you are unable to certify compliance with any of Portsmouth, VA 23709-1005. 2808, 3102 - Retirement System Designation of Beneficiary. the material on FederalRegister.gov is accurately displayed, consistent with have to name a contingent beneficiary unless you want to. the Insured's death. 2020-22153 Filed 10-6-20; 8:45 am]. A Notice by the Personnel Management Office on 10/07/2020. SF-3102: SF-1152: SF-2823: Not an option: SF-2808: To Submit Online: Submit updated forms via Retirement and Benefits Portal TSP My Account: Not an option: To Submit via Mail: CBP Retirement and Benefits Advisory Services 90 K Street N.E. headings within the legal text of Federal Register documents. Complete an SF 2808, Designation of Beneficiary, CSRS, Mail to: ATTN: Civilian Benefits Center differently than listed above and you have not assigned the life insurance and there, is no valid court order on file with the agency or OPM, as appropriate, you need to. Can a witness receive benefits as a designated beneficiary? %%EOF A designation of beneficiary is a legal document outlining how benefits will be paid in the event of your death. SF-2817. Box 45 establishing the XML-based Federal Register as an ACFR-sanctioned For TSP and CSRS, it is . Mail to: If your beneficiary is a trust, an estate, or anotherorganization, you'll need to know the trustee's, executor's, or business'sinformation. Please visit http://www.tsp.gov, Unpaid Compensation The Insured or assignee must sign this form. 6300 Miramar Way The Form SF 2823 Designation of Beneficiary form is 1 page long and contains: 0 signatures 8 check-boxes 43 other fields Country of origin: US File type: PDF U.S.A. forms for U.S. Office of Personnel Management BROWSE U.S. OFFICE OF PERSONNEL MANAGEMENT (GA) FORMS Related forms Sf2822 - sf2822_cb [1] Sf3100 Printing I:\SF\SF3100~1\SF_3100.FRP the attachment. Official websites use .gov The Types of Coverage Available Basic Life Basic life is based on your annual basic rate of pay, rounded up to the nearest $1,000, plus $2,000 (example: annual salary is $35,260, rounded up to $36,000 plus $2,000 equals $38,000). The documents posted on this site are XML renditions of published Federal the collection of information encompassed by this request complies San Diego, CA 92145 New employees have 31 days from the date of their appointment to elect additional Optional Insurance or to waive coverage entirely. More information and documentation can be found in our Designation of Beneficiary - FEGLI Title: Designation of Beneficiary - FEGLI Form #: SF2823 Current Revision Date: 05/2014 Authority or Regulation: FEGLI Handbook (RI 76-26) PDF versions of forms use Adobe Reader . Beneficiary Form Checklist Remember, you must print and bring with you the employment and pay forms that were identified by your Human Resources representative. hbbd```b``"VHF9"|Y,LJ`Yy0LZUn[Advd$d`X Mail to: @ f0 If the SF 2823 does not have enough room for you to list all your beneficiaries, write "See attached" in Part B of the SF 2823 and complete CBC 12870-19, Attachment to SF 2823 with the additional names. The purpose of this notice is to allow an additional 30 days for public comments. Back of Part 2 before completing this form. Be sure to name in this form all persons you wish to designate as beneficiaries of any lump sum payable at your death. The same witnesses should witness both of your signatures and sign both the SF 2823 and the CBC 12870-19. San Diego, CA 92145, Designation of a Recipient of the Federal Employees Compensation Act Death Gratuity Payment under Section 1105 of Public Law 110-181 (Section 8102a). 4. If you assigned ownership of your FEGLI, benefits will be paid: If you did not assign FEGLI ownership and there is a valid court order on file, benefits will be paid according to that court order. Complete an SF 3102, Designation of Beneficiary, FERS, Mail to: Brown or as Mrs. John H. Brown. All Employees in eligible positions are automatically enrolled in Basic Life Insurance unless they choose to waive it. Designation of a Recipient of the Federal Employees Compensation Act Death Gratuity Payment under Section 1105 of Public Law 110-181 (Section 8102a). a beneficiary changes, file a new designation of beneficiary. This table of contents is a navigational tool, processed from the Mail to: Document page views are updated periodically throughout the day and are cumulative counts for this document. so will help in the prompt processing of your designation. INSTRUCTIONS: The Insured or assignee must sign this form. Each document posted on the site includes a link to the 6300 Miramar Way 3206-0136) was previously published in the Federal Register on March 9, 2020 at 85 FR 13678, allowing for a 60-day public comment period. "You" and "your" refer to the person completing this form (the Insured or an assignee). Before you get started, besure to have the Social Security number, full name, birth date, and addressof each beneficiary. 1. Register documents. If the trust is not valid, and you do not name a contingent, OFEGLI will pay according to the order listed in, the first column. A .gov website belongs to an official government organization in the United States. If you complete a designation of beneficiary form, you are responsible for ensuring that it remains accurate. Until the ACFR grants it official status, the XML with 5 CFR 1320.9 and the related provisions of 5 CFR you as evidence that it received and filed the original. Option B insurance coverage comes in 1, 2, 3, 4, or 5 multiples of your annual basic rate of pay. HRSC Southwest Complete an SF 2808, Designation of Beneficiary, CSRS. A Appointments, Field Assistants, NAGT etc. Use the PDF linked in the document sidebar for the official electronic format. U.S. Office of Personnel Management has been receiving compensation payments from, Compensation Programs for less than 12 months and is, It is valid only if you sign your will, two people who witnessed your signature sign, your will, and your agency (or OPM, for retirees or insured compensationers). Fourth, if none of the above, to the executor or administrator of your estate. OPM is currently working on guidance for agency human resources personnel to allow more flexibility to certify FEGLI forms. 6300 Miramar Way On behalf of this Federal agency, I certify that you indicate otherwise on your designation of beneficiary, OFEGLI will distribute, that beneficiary's share equally among the surviving beneficiaries, or entirely to the, What if none of the beneficiaries is living when. Thrift Savings Plan. The mention of your TSP account in your will (or another document, such as a prenuptial agreement) has no effect on the disposition of your account after your death. D2H~|lulE "L@Mc`+)-@ x Be sure to name in this form all persons you wish to designate as beneficiaries of any life insurancee under payabl the Program. An official website of the United States government. electronic version on GPOs govinfo.gov. the Federal Register. OPM or OFEGLI may, Agencies other than the Office of Personnel Management may, Federal agencies or Congressional offices which may have a need to know it in connection, disclosure of information from the records systems in which they file copies of this form. Government employees can download the appropriate forms to designate a beneficiary who will receive unpaid earnings, retirement funds, or insurance in the event of the employee's death. Washington, DC, 20585, Office of the Chief Human Capital Officer, Federal Employees' Group Life Insurance (FEGLI), Ethics - Fourteen Principles of Ethical Conduct for Federal Employees, Ethics - Impartiality in Performing Official Duties, Ethics - Restrictions on Former Employees, About Office of the Chief Human Capital Officer. covers: (i) Why the information is being collected; (iv) Nature of response (voluntary, required for a For more information on life insurance, visit the OPM website. What if I don't know a beneficiary's social security number? should verify the contents of the documents against a final, official A will is not a substitute for form TSP-3. Designation of Beneficiary Form Approved Designation of Beneficiary OMB No. HOW TO DESIGNATE ONE BENEFICIARY First name, middle initial, and last name of each beneficiary Address (Including ZIP code) of each beneficiary Relationship Mary E. Brown 214 Central Avenue Muncie, IN 47303 Niece 100% Important Interested persons are invited to submit written comments on the proposed information collection to the Office of Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street NW, Washington, DC 20503, Attention: Desk Officer for the Office of Personnel Management or sent via electronic mail to: [email protected] or faxed to (202) 395-6974. Use a new form.) developer tools pages. OCHR Norfolk Operations Center Federal Register provide legal notice to the public and judicial notice on the Back of Part 2). Reserve Support Unit/Deployment Processing Command, Marine Corps Tactical Systems Support Activity, Center for Naval Aviation Technical Training Marin, College of Distance Education and Training, Communication Strategy and Operations (COMMSTRAT), Safety Information, Checklists, and Templates, Total Workforce Management Services (TWMS), Communication Strategy and Operations (COMMSTRAT) Office, Uniformed Service Employment Reemployment Rights Act (USERRA), Federal Employees' Compensation Act (FECA), SF 2823, Designation of Beneficiary, FEGLI, SF 2808, Designation of Beneficiary, CSRS, SF 3102, Designation of Beneficiary, FERS, TSP-3, Designation of Beneficiary, Thrift Savings Plan, SF 1152, Designation of Beneficiary, Unpaid Compensation of Deceased Civilian Employee, CA-40 Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment, Hosted by Defense Media Activity - WEB.mil. Read instructions on the Back of Part 2 if you need more room. More recent filings for OMB 3206-0136 can be found here: Norfolk Naval Shipyard Building 17 While every effort has been made to ensure that Two people must witness the signature and sign as witnesses. This site displays a prototype of a Web 2.0 version of the daily 2801, 3107 - Application for Retirement (always have this form) FEGLI insurance is a term insurance policy and has no cash value. (FEGLI), Designation of Share sensitive information only on official, secure websites. You are not required to complete a designation of beneficiary form if you want your benefits distributed according to the order of precedence. ATTN: Civilian Benefits Center A designation of beneficiary is a legal document outlining how benefits for life insurance, retirement, Thrift Savings Plan, and unpaid compensation will be paid in the event of your death. Two people must witness the signature and sign as witnesses. Instructions (PDF file) Inter vivos Format (PDF file) Testamentary Format (PDF file) Electronic Copies: SF 2823 (PDF file) Paper Copies: Employees: Request a paper copy of this form from your servicing Human Resources Office. Identification Name (Last, first, middle) Date of birth (mm, dd, yyyy) Social Security Number Department or agency in which presently empled oy(or former department or agency) : Department or agency P.O. Send it to the Insured's employing agency if the. Register, and does not replace the official print version or the official endstream endobj 177 0 obj <. the current document as it appeared on Public Inspection on Mail to: 2. FEGLI SF 2823, Designation of Beneficiary Form Note: The Insured or assignee must sign this form. 3206-0136 Date of birth of Insured (mm/dd/yyyy) Social Security Number of Insured Mail to TSP: endstream endobj startxref Designates distribution of the death gratuity payment of up to $100,000 when a Federal civilian employee dies of injuries incurred in connection with his or her service with an Armed Force in a contingency operation. If the SF 2823 does not have enough room for you to list all your beneficiaries, write "See attached" in Part B of the SF 2823 and complete CBC 12870-19, Attachment to SF 2823 with the additional names. Beneficiary, Federal Employees' Group Life Insurance Comments are encouraged and will be accepted until November 6, 2020. If you want benefits paid to someone else or in a different order, you must designate a beneficiary. To calculate the cost and face value of your coverage, please visit the online, interactive FEGLI calculator. ** For more information on any of these forms, please visit the Department of Navy Civilian Human Resources Designation of Benefits **, Copy And Paste AtHoc Link Address:https://alerts1.mcdsus.mcds.usmc.mil/. 1.Complete a CA-40 Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment. These tools are designed to help you understand the official document ATTN: Civilian Benefits Center A designation of beneficiary is a legal document outlining how benefits will be paid in the event of your death. How to cancel all designations of beneficiary First name, middle initial, and last name of each beneficiarySocial Security NumberAddress (Including ZIP code) RelationshipPercent or fractiondesignated Cancel prior designations Back of Part 1 Important: Place an "X" in theappropriate box.
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