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Category: 


Retired Pay

			    

Subcategory: 


Notification of Death


			    
			      
			    

Name: 


First*:
				        Middle:
				        Last*:

			
			    
			      
			    

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Email*:
				        Re-enter Email*:

			
	        

            
				
					
				

Passcode*: 


Create a passcode for this ticket to view information and responses. Passcodes must be a minimum of 15 characters and contain at least one lowercase letter, one uppercase letter, one number, and one special character. Passcodes cannot contain your name or email address. Safeguard your passcode for future use.

			
				
			    
			    
			    
			      
				      
				        
				      
				      
				      
	            Retiree's First Name*: 


This can be used to report the death of a MILITARY RETIREE ONLY. If the person you are reporting is not a Military Retiree, the request will not be processed.

				      
				      
				      
				            
	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            Retiree's Last Name*:

				      
				      
				      
				            
	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            Retiree's  SSN*: 


Please enter SSN without dashes.
			        
				      
				      
				            
	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            Date of Death*: 


Please pick the date below.

	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            Cause of Death*: 


-- Select One --NaturalHomicidePendingOther
			        
				      
				            
	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            Is the Retiree Married?*: 


-- Select One --YesNo
			        
				      
				            
	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            Are you the Spouse?*: 


-- Select One --YesNo
			        
				      
				            
	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            If Spouse, enter marriage date: 


Please pick the date below.

	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            What is your relation to Retiree?*: 


-- Select One --SpouseSonDaughterMotherFatherSisterBrotherOther
			        
				      
				            
	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            Your Street Address*: 


If you are located at a FOREIGN ADDRESS, you can also type that address in the below field.

				      
				      
				      
				            
	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            City*: 


For FOREIGN ADDRESSES, please include City and your Country.

				      
				      
				      
				            
	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            State: 


Required for US addresses. (Drop down does include AA, AE, AP) Not required for foreign addresses.

-- Select One --AKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYAAAEAPAmerican SamoaGuamNorthern Mariana IslandsPuerto RicoVirgin Islands
			        
				      
				            
	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            Zip Code: 


Required for US addresses. Not required for foreign addresses.

				      
				      
				      
				            
	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            Phone Number*: 


Please enter your Phone Number, without dashes. (US & overseas phone numbers)

				      
				      
				      
				            
	            
	
	            
	
	            
				      
	            
	
	                  
				      
				      
			      
			    
			      
				      
				        
				      
				      
				      
	            **Important information on DFAS procedures following the report of a death**

===============================
Note: DFAS will stop monthly payments upon notification of death to prevent overpayment. DFAS is required to notify the bank and reclaim any payment in-full that was made after the Retiree's date of death.
===============================

Please click the "Submit" button below to report the death of the Retiree:
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**Information Types Subject to Gathering:** Social Security Number (SSN) (full or in any form)
					Birth Date
					Child Information
					Citizenship
					Disability Information
					DoD ID Number
					Driver's License
					Employment Information
					Financial Information
					Gender/Gender Identification
					Home/Cell Phone
					Law Enforcement Information
					Legal Status
					Mailing/Home Address
					Marital Status
					Medical Information
					Military Records
					Mother's Middle/Maiden Name
					Name(s)
					Official Duty Address
					Official Duty Telephone Number
					Other ID Number
					Personal E-mail Address
					Place of Birth
					Position/Title
					Protected Health Information (PHI)
					Race/Ethnicity
					Rank/Grade
					Work E-mail Address

					In addition to the above, other data elements may be requested or required in the course of researching and responding to ticket submissions.