Federal Employees 

Retirement System 

 ̄

U.S. Office of Personnel Management 

5 CFR 843.205 NSN 7540-01-246-9252 3102-104 

Designation of Beneficiary 

Federal Employees Retirement System 

Standard Form 3102 

Previous editions are not usable. Revised December 2006 

Form Approved 

OMB No. 3206-0173 

Important:

Read all instructions before 

filling in this form 

A. Identification 

Name (Last, first, middle) Date of birth (mm/dd/yyyy) Social Security Number 

Place an "X" in the 

appropriate box:

An employee Retired or an 

applicant for 

retirement 

Former employee eligible 

for retirement in the 

future 

If you are retired give your claim number 

Department or agency in which presently employed (or former department or agency): 

Department or agency Bureau Division Location (City, state and ZIP code) 

I, the individual identified above, designate the beneficiary or beneficiaries 

named below to receive any lump-sum benefit which may become payable 

under the Federal Employees Retirement System (FERS) after my death, 

including lump-sum death benefits which may become payable based on 

amounts contributed to the Civil Service Retirement System (CSRS) before 

I became covered by FERS. I understand that this designation of beneficiary 

cancels any previous FERS or CSRS designation of beneficiary, and that it 

remains in effect until I cancel it in writing or I receive payment of my 

FERS retirement contributions. 

I direct, unless otherwise indicated below, that if more than one 

beneficiary is named, the share of any beneficiary who may predecease 

me or who may be disqualified for any other reason, shall be distributed 

equally among the stated beneficiaries, or entirely to the survivor. If none 

of the beneficiaries are alive and eligible to receive payment when a 

lump-sum payment becomes payable, this designation is void, and 

payment will be made according to the order of precedence set by law. 

B. Information Concerning The Beneficiaries (See Examples of Designations): 

First name, middle initial, and last 

name of each beneficiary 

Address (Including ZIP code) of 

each beneficiary 

We will write to the address you provide here to contact the person you designate. However, that person is obligated to get in touch with us after your death to ask us to make 

payment. 

Relationship 

to you 

 We will pay to the person you designate, even if that person's name or relationship to you changes after you file this designation. For example, suppose you designate your spouse 

and then you two divorce and you marry someone else. We will pay any lump sum to your former spouse unless you submit another designation to cancel prior designations or to 

designate who we are to pay.

Share to be paid to 

each beneficiary 

Date of designation (mm/dd/yyyy) Your signature 

Total = 100% 

C. Witnesses (A witness is not eligible to receive payment as a beneficiary): 

We, the undersigned, certify that this statement was signed in our presence. 

Signature of witness Address (including ZIP code) 

Signature of witness Address (including ZIP code) 

Receiving agency certification 

I have reviewed this designation and certify that the designated shares total 100% and that no witnesses are designated as beneficiaries. 

Date received by agency (mm/dd/yyyy) Signature Date (mm/dd/yyyy) 

Type or print your return address so that we can return a copy to you. 

See Back of Employee Copy For Instructions 

On Where To File This Form. 

(Retain until employee leaves Federal 

service and then send to the Office of Personnel 

Management [OPM].) 
Important - The filing of this form will completely cancel any Designation of Beneficiary under the Federal Employees Retirement System or under the Civil 

Service Retirement System you may have previously filed. Be sure to name in this form all persons you wish to designate as beneficiaries of any lump sum 

payable at your death. 

Examples of Designations 

1. HOW TO DESIGNATE ONE BENEFICIARY Do not write names as M.E. Brown or as Mrs. John H. Brown. If you want to designate your estate as 

beneficiary, enter "My estate" in the beneficiary column. 

First name, middle initial, and last 

name of each beneficiary 

Address (Including ZIP code) 

of each beneficiary 

Relationship 

to you 

Share to be paid to 

each beneficiary 

Mary E. Brown 214 Central Avenue 

Muncie, IN 47303 

Niece 100% 

2. HOW TO DESIGNATE MORE THAN ONE BENEFICIARY Be sure that the shares to be paid to the several beneficiaries add up to 100 percent. 

First name, middle initial, and last 

name of each beneficiary 

Address (Including ZIP code) 

of each beneficiary 

Relationship 

to you 

Share to be paid to 

each beneficiary 

Alice M. Long 509 Canal Street 

Red Bank, NJ 07701 

Aunt 25% 

Joseph P. Brady 360 Williams Street 

Red Bank, NJ 07701 Nephew 25% 

Catherine L. Rowe 792 Broadway

Whiting, IN 46394 Mother 50% 

3. HOW TO DESIGNATE A CONTINGENT BENEFICIARY 

First name, middle initial, and last 

name of each beneficiary 

Address (Including ZIP code) 

of each beneficiary 

Relationship 

to you 

Share to be paid to 

each beneficiary 

John M. Parrish, if living 810 West 180th Street 

New York, NY 10033 

Father 100% 

Otherwise to: Susan A. Parrish 810 West 180th Street 

New York, NY 10033 

Sister 100% 

4. HOW TO DESIGNATE AN INTER VIVOS TRUST (A trust that you set up during your lifetime) 

First name, middle initial, and last 

name of each beneficiary 

Address (Including ZIP code) 

of each beneficiary 

Relationship 

to you 

Share to be paid to 

each beneficiary 

Trustee(s) or Successor

Trustee(s) as provided in the

John Q. Public Trust 

Agreement dated 12/18/1999,

if valid. Otherwise to: 

Trustee 100% 

Mary E. Brown 

214 Central Avenue 

Muncie, IN 47303 Niece 100% 

5. HOW TO DESIGNATE A TESTAMENTARY TRUST (A trust that is set up when you die, according to terms in your will) 

First name, middle initial, and last 

name of each beneficiary 

Address (Including ZIP code) 

of each beneficiary 

Relationship 

to you 

Share to be paid to 

each beneficiary 

Trustee(s) or Successor

Trustee(s) as provided in my

Last Will and Testament, if 

valid. Otherwise to: 

Trustee 100% 

Maria Sufuentes 5909 Pacific Avenue, NW 

Washington, DC 20019 

Niece 100% 

6. HOW TO CANCEL A DESIGNATION OF BENEFICIARY AND EFFECT PAYMENT UNDER ORDER OF PRECEDENCE (See back of employee copy) 

First name, middle initial, and last 

name of each beneficiary 

Address (Including ZIP code) 

of each beneficiary 

Relationship 

to you 

Share to be paid to 

each beneficiary 

Cancel prior designations 

Standard Form 3102 (Reverse of Part 1) 

Revised December 2006
Do not fill out this form until you have read the information and instructions below 

Instructions

This Designation of Beneficiary Form is used to designate who is to receive a lump-sum payment which may become payable under the Federal Employees 

Retirement System (FERS). It does not affect the right of any person who is eligible for survivor annuity benefits. This form may not be used and will not be 

effective in any way to elect, or demonstrate the intent to elect, a survivor annuity for a spouse, former spouse, or an individual who has an insurable interest in 

an employee. Do not confuse this form with designation forms used for other types of benefits: Standard Form 2808, Designation of Beneficiary - Civil Service 

Retirement System; Standard Form 2823, Designation of Beneficiary - Federal Employees' Group Life Insurance Program; TSP-3, Federal Retirement Thrift 

Savings Plan Designation of Beneficiary; or Standard Form 1152, Designation of Beneficiary - Unpaid Compensation of Deceased Civilian Employee. 

This form is only for employees and retirees under FERS. Employees and retirees under the Civil Service Retirement System (CSRS) must use Standard Form 

2808, Designation of Beneficiary - Civil Service Retirement System. If you transferred from CSRS to FERS and previously filed an SF 2808, Designation of 

Beneficiary - Civil Service Retirement System, your SF 2808 is invalid. You must file a new designation using this form. 

Important - The filing of this form will completely cancel any Designation of Beneficiary under FERS or CSRS (SF 3102 or SF 2808) you may have previously 

filed. Be sure to name in this form all persons you wish to designate as beneficiaries for FERS lump-sum death benefits, including lump sum payment of 

amounts you may have contributed to CSRS before becoming covered by FERS. 

Order of Precedence 

You do not need to make a designation if you are satisfied with the order of 

precedence that the law provides. That order of precedence follows: 

1. To your widow or widower. 

2. If your widow(er) is deceased, to your child or children, with the share of 

any deceased child distributed among the descendants of that child. 

3. If none of the above, to your parents in equal shares or the entire 

amount to the surviving parent. 

4. If none of the above, to the executor or administrator of your estate. 

5. If none of the above, to your other next of kin under the laws of the State 

in which you live at the time of your death. 

Payment of a lump sum will be made to the first person or persons listed 

above who are alive on the day you die. 

Designating a Beneficiary 

1. You can designate any person, firm, corporation, trust, or legal entity as 

your beneficiary. 

If you want to designate a trust, see examples 4 and 5 on the back of 

Part 1. Those examples name a contingent beneficiary in case the trust 

is not valid. You don't have to name a contingent beneficiary unless you 

want to. If the trust is not valid, and you do not name a contingent 

beneficiary, OPM will pay according to the order listed under "Order of 

Precedence" above. 

2. You can change your beneficiary at any time, without the knowledge or 

consent of a previous beneficiary, and this right cannot be waived or 

restricted. 

3. A designation of beneficiary must be in writing, signed, and witnessed. 

If you are an employee, the designation must be received in your 

employing office prior to your death. If you are a separated employee, 

a retiree or a person receiving recurring payments from the Office of 

Workers' Compensation Programs (OWCP), the designation must be 

received by the Office of Personnel Management (OPM) prior to your 

death. 

4. A witness to a designation of beneficiary is ineligible to receive payment 

as a beneficiary. 

5. The person(s) named will be considered a beneficiary (beneficiaries) for 

both CSRS and FERS lump-sum benefits. 

6. You cannot change or cancel a designation of beneficiary in a last will 

or testament unless it is signed, witnessed, and filed as described in 

paragraph 3. 

7. A designation of beneficiary remains in effect until (1) you cancel it by 

filing a new designation, or (2) you receive a refund of your retirement 

deductions before retirement. To inform us if the name or address of a 

beneficiary changes, file a new designation of beneficiary. It may be 

important to file a new designation if your family situation changes. 

Completing the Designation Form 

1. 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. 

2. If you designate more than one beneficiary, be sure that the shares to 

be paid to them add up to 100 percent. 

3. Complete the form in duplicate. Type or print all entries except 

signatures. Do not use pencil. 

4. Do not erase or alter entries. 

Where to Submit the Completed Form 

For employees: File this form with your employing agency, even if you are 

retiring. 

For separated employees, retirees and individuals receiving recurring 

benefits from the Office of Workers' Compensation Programs (OWCP): 

If you have left Federal employment, if you are receiving recurring benefits 

from the Office of Workers' Compensation Programs, or if you have retired, 

file this form with the Office of Personnel Management, Retirement 

Operations Center, Federal Employees Retirement System, P.O. Box 45, 

Boyers, PA 16017-0045. 

Your designation will not be effective until the date it is received by your 

employing agency (or OPM if you are not employed). 

The employee copy of this form will be noted and returned to you as 

evidence that the original has been received and filed. Please keep the 

duplicate in a safe place along with your other important papers. 

For the employing agency: File the Official Personnel Folder (OPF) copy 

on the right side of the OPF. If the employee leaves Federal service, send 

all FERS designations in the OPF to OPM. 

Privacy Act and Public Burden Statements 

Solicitation of this information is authorized by the Civil Service Retirement law 

(Chapter 83, title 5, U.S. Code) and the Federal Employees Retirement law (Chapter 

84, title 5, U.S. Code). The information you furnish will be used to determine who will 

receive a lump sum benefit in the event of your death. The information may be shared 

and is subject to verification, via paper, electronic media, or through the use of 

computer matching programs, with national, state, local or other charitable or social 

security administrative agencies in order to determine benefits under their programs, 

to obtain information necessary for determination of benefits under this program, or 

to report income for tax purposes. It may also be shared and verified, as noted 

above, with law enforcement agencies when they are investigating a violation or 

potential violation of civil or criminal law. 

Executive Order 9397 (November 22, 1943), authorizes the use of the Social Security 

Number. Failure to furnish the requested data may delay or make it impossible for us 

to determine how to make payment in the event of your death. 

We think providing this information takes an average of 15 minutes per response to 

complete, including the time for reviewing instructions, getting the needed data, and 

reviewing the completed form. Send comments regarding our estimate or any other 

aspect of SF 3102, including suggestions for reducing completion time, to the U.S. 

Office of Personnel Management (OPM), OPM Forms Officer (3206-0173), 

Washington, D.C. 20415-7900. The OMB number, 3206-0173 is currently valid. OPM 

may not collect this information, and you are not required to respond, unless this 

number is displayed. 

Standard Form 3102 (Reverse of Part 2) 

Revised December 2006