ATTACHMENT 2 

Summary of Benefits Checklist 

Upon the Death of a Federal Employee 

The benefits based on the death of a Federal employee applicable to your claim are 

checked below. Only the items checked below apply to you. In most cases, you have 

the option of filling out the forms on-line at: www.opm.gov/forms 

FEDERAL EMPLOYEES' GROUP LIFE INSURANCE (FEGLI)

 Attached is an FE-6, Claim for Death Benefits that must be completed to file for life insurance 

benefits. (You may fill out the form on-line.) Each claimant must submit a separate form. 

Mail the completed claim form together with a certified copy of the death certificate and any 

other required documents listed under “Additional Information” to (new address as of June 15, 

2009): 

Office of Federal Employees’ Group Life Insurance 

P. O. Box 6512 

Utica, NY 13504-6512 

If the amount payable to you is less than $5,000, you will receive a single check for the entire 

amount. If the amount payable to you is $5,000 or more, the Metropolitan Life Insurance 

Company, administrator of the FEGLI program, will open a Money Market Option Account in 

your name. You will receive a checkbook giving you complete control of and immediate access 

to all of your funds. You may write checks for all or part of the money (minimum amount is 

$250.00) in your account beginning the first day you receive your checkbook. 

Life insurance cannot be paid directly to a minor. In most states, adulthood is attained at 18 

years of age. When a minor is entitled to payment of benefits, the Office of Federal Employees' 

Group Life Insurance (OFEGLI) will: pay the court-appointed guardian of the minor child's 

estate; pay the parent(s) of the minor child, if the proceeds are $10,000 or under; or hold the 

proceeds on deposit until the minor child reaches adulthood. 

If there is no guardian and there are no plans to appoint one, and the proceeds are greater than 

$10,000, OFEGLI will hold the funds in the minor’s name in an interest bearing account until the 

minor reaches age 18. For additional information for payment to a minor child(ren): 

www.opm.gov/insure/life/reference/handbook/claims2.asp#minor 

If you mailed your claim form(s) no sooner than 30 days ago and have questions about the 

status, you may call OFEGLI at 1-800-633-4542.

 Attached is an SF2819, Notice of Conversion Privilege, because the employee was enrolled 

in Option C-Family. You have the opportunity to convert Option C-Family coverage. 

 There are no life insurance benefits payable under FEGLI because the deceased Federal 

employee did not participate in the program. 

 You do not appear to be eligible for FEGLI benefits or you are not the designated beneficiary; 

however, you may still file a claim. Contact the Benefits Specialist for a claim form or you may 

complete the form FE-6 on-line. OFEGLI will determine your eligibility for benefits. 

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BENEFITS FROM THE RETIREMENT SYSTEM

Survivor and Lump Sum Benefits 

Civil Service Retirement System (CSRS) 

 You appear to be eligible for a monthly survivor annuity payable by the U.S. Office of 

Personnel Management (OPM) 

 You do not appear to be eligible for a monthly survivor benefit, but appear to be eligible for a 

lump sum payment of the Federal employee’s retirement contributions 

 You do not appear eligible for any benefits payable by the U.S. OPM. However, if you 

believe benefits are payable to you, you must apply to OPM which will provide you with a formal 

decision 

 Enclosed is a SF 2800, Application for Death Benefits (CSRS) 

 

 

Federal Employees Retirement System (FERS)

 You appear to be eligible for spousal FERS lump sum death benefits Basic Employee Death 

Benefit (BEDB) in the amount of____________ 

 You appear to be eligible for a monthly survivor annuity payable by the U.S. Office of 

Personnel Management (OPM) 

 You do not appear to be eligible for a monthly survivor benefit, but appear to be eligible for a 

lump sum payment of retirement contributions 

 You do not appear to be eligible for a monthly survivor benefit and you are not the designated 

beneficiary for lump sum benefits 

 You do not appear eligible for any benefits payable by the U.S. OPM. However, if you 

believe benefits are payable to you, you must apply to OPM and OPM will provide you with a 

formal decision 

 Enclosed is an SF 3104, Application for Death Benefits (FERS)

Computation of Survivor Annuity

 Estimate of Monthly Annuity. Enclosed is an estimate of your monthly survivor annuity 

(without deductions for taxes). This is just an estimate since only the Office of Personnel 

Management (OPM) can authorize benefits. Contact the Benefits Specialist (listed on Page 8 of 

this Checklist) if you need an explanation of the survivor benefits payable to you. 

 Deposit For Military Service. The deceased Federal employee performed active duty 

military service on or after January 1, 1957. There is no indication that the Federal employee 

had made a deposit for this service. Therefore, you will have to make a written election 

concerning whether to include this service in the computation of your benefits. To include the 

military service in the computation of your survivor annuity, you will have to make a lump sum 

deposit. 

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 The deposit amount is determined using base pay earned during the period of active duty 

service. The Benefits Specialist will provide you an estimate of the deposit required and an 

election form when the earnings have been received from the Military Finance Center 

 Based on the earnings received from the Military Finance Center, we have computed the 

survivor benefits with and without military service. We have included the computations for you 

to make an informed decision as to making the deposit 

 Survivor’s Military Service Election Form (SF 3104B) needs to be completed concerning 

military retired pay and whether or not you may want to pay the military deposit 

Monthly Benefits For Children

 It appears that children’s survivor benefits may be payable. The amount of the children’s 

survivor benefit is the lesser of __________ per child or ___________ divided by the 

number of eligible children, if over 3 children. (This amount depends on the number of 

children and whether the child has a living parent who was married to the employee.) 

 Since the deceased was covered under FERS, you must apply for benefits from the Social 

Security Administration (SSA) for minor or disabled children as soon as possible. The amount 

of the children’s benefit is offset by the total amount payable to children by Social Security. You 

should submit a copy of SSA’s notice of award or denial with your application for death benefits, 

if available. If the notice of award or denial is not submitted, OPM will obtain the information 

from SSA, however, this may delay the processing of your claim. 

 Enclosed is an RI 25-41, Initial Certification of Full-time School Attendance, which should be 

completed and included with the Application for Death Benefits for children between the ages of 

18 and 22 who are full-time students. 

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Forms To File For Benefits From The Retirement System

 Attached is an OPM pamphlet SF 2800-1, Applying for Death Benefits Under the Civil Service 

Retirement System. To file for CSRS benefits, please complete the attached SF 2800, 

Application for Death Benefits (CSRS). Mail the completed claim form together with a certified 

copy of the death certificate, copy of your marriage certificate, copy of birth certificates for 

children, if applicable, and any other required documents listed below under “Additional 

Information” to: 

If using US Postal Service:

 US Office of Personnel Management 

 Retirement Operations Center 

 Survivor Processing Section 

 PO Box 45 

 Boyers, PA 16017-0045

If using FEDEX, UPS or DHL:

 US Office of Personnel Management

 Retirement Operations Center 

 Survivor Processing Section

 1137 Branchton Road

 Boyers, PA 16017

 Attached is OPM pamphlet SF 3114, Applying for Death Benefits Under the Federal 

Employees Retirement System. To file for FERS benefits, please complete the attached SF 

3104, Application for Death Benefits. Mail the completed claim form together with a certified 

copy of the death certificate, copy of your marriage certificate, copy of birth certificates for 

children, if applicable, and any other required documents to: 

If using US Postal Service:

 US Office of Personnel Management 

 Retirement Operations Center 

 Survivor Processing Section 

 PO Box 45 

 Boyers, PA 16017-0045

If using FEDEX, UPS or DHL:

 US Office of Personnel Management

 Retirement Operations Center

 Survivor Processing Section

 1137 Branchton Road

 Boyers, PA 16017

NOTE: A widow/widower who is entitled to a benefit in her/his own right and also 

on behalf of a child(ren), only needs to file one application. 

Status of Processing of Benefits By OPM 

Once you have submitted your application for benefits to OPM you may call OPM toll free at: 

1-888-767-6738 or 202-606-0500 if in the Washington, DC area, from 7:30 a.m. to 7:45 p.m. 

(Eastern Time) Monday through Friday, except Federal holidays, to request the status of your 

claim. Please allow sufficient time for OPM to process your application. 

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THRIFT SAVINGS PLAN (TSP) 

For general information about the Thrift Savings Plan (TSP), go to: www.tsp.gov . 

 You appear to be eligible for TSP benefits; the Federal Retirement Thrift Investment Board 

administers TSP benefits 

If you are a spouse, your withdrawal options are to either receive a single, lump sum payment or 

roll the entire account balance into an Individual Retirement Arrangement (IRA). Payments 

made to non-spouse beneficiaries cannot be transferred to an IRA or other eligible retirement 

plan. The TSP Office will provide you with information about death benefit payments. 

Attached is “Important Tax Information About Thrift Savings Plan Death Benefit Payments 

and a TSP-17, Application for Account Balance of Deceased Participant. Complete the 

TSP-17 and mail it with a certified copy of the death certificate and any required documents 

listed below under “Additional Information” to:

TSP Death Benefits Processing Unit 

Fairfax Post Office-DEDIS

PO Box 4450

Fairfax, VA 22038-9998

Once you have submitted your application, you may contact the Thrift Board toll free at: 

1-877-968-3778 from 7:00 a.m. to 9:00 p.m. (Eastern Time) Monday through Friday, except 

Federal holidays, to request the status of your claim. Please allow sufficient time for the 

Thrift Board to process your application. 

 You do not appear eligible for TSP benefits; however, you may file a claim. Please contact 

your Benefits Specialist (listed on Page 8 of this Checklist) for a claim form or you may 

download the TSP-17. The TSP Office will determine your eligibility for TSP benefits. 

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UNPAID COMPENSATION

Unpaid compensation is any additional compensation that was earned by the 

deceased employee, but not paid. It includes unpaid salary, a lump sum 

payment for annual leave, unpaid travel vouchers, amount due as a refund of 

salary deductions for U. S. Savings Bonds and payment for any earned 

compensatory time. 

Only the checked items below need your attention. You have the option of filling out 

the forms on-line at: www.opm.gov/forms 

 Attached is SF 1153, Claim For Unpaid Compensation of Deceased Civilian 

Employee that must be completed to file for the unpaid compensation benefits. 

Please note that you must sign this form in the presence of two witnesses who also 

must sign the form; it’s not necessary to have it notarized. 

 Attached is the Election Regarding Method of Payment of Unpaid 

Compensation. The completed form should be attached to the SF 1153.

 Since the deceased Federal employee was not working at the time of death and 

does not appear to have any annual leave, there may not be any unpaid 

compensation benefits. 

 You do not appear eligible for any unpaid compensation benefits; however, you 

may still file a claim. Please contact your Benefits Specialist (listed on Page 8 of 

this Checklist) for a claim form or you may complete the form on-line. 

Please return the completed forms with a certified copy of the death certificate and 

any required documents listed below under “Additional Information” to the Agency at 

the address listed below.

Agency Address: 

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FEDERAL EMPLOYEES HEALTH BENEFITS (FEHB)

 You are entitled to continue health benefits coverage under the FEHB program and 

the coverage will be automatically transferred to your name by OPM. Your coverage will 

not be interrupted in the transition to OPM.

 Since at least one family member appears to be eligible to continue FEHB coverage 

as a survivor annuitant, premiums will be withheld from the monthly survivor annuity.

 You appear eligible to continue FEHB coverage. Since you do not appear to be 

eligible for a monthly survivor annuity, OPM will notify you regarding premium payment 

procedures.

 You do not appear to be eligible to continue FEHB coverage since you were not a 

covered family member under an FEHB plan at the time of the employee’s death.

 The deceased Federal employee was not enrolled in FEHB 

ADDITIONAL INFORMATION

Please include a certified copy of the death certificate and the applicable documentation 

listed below for each of the completed claim forms you are submitting. Note: The death 

certificate should show the manner of death. If the death is pending investigation or a 

homicide, OPM would need to know this prior to processing payment. 

For a spouse:

• Copy of marriage certificate (does not have to be a certified copy)

• If the deceased was previously married, copy of the complete court order of 

divorce or annulment

For a former spouse:

• If not previously submitted to OPM, a complete certified copy of the divorce 

decree, including property settlement

For a child:

• Copy of child’s birth certificate (does not have to be a certified copy but 

should show the names of both parents)

• Medical documentation for disabled child(ren)

• Adoption papers for adopted child(ren)

• Guardianship papers for child(ren) if there is a court appointed guardian

 

If you are the parents of the deceased employee:

• Copy of deceased employee’s birth certificate (does not have to be a 

certified copy)

If you are the executor of the estate:

• Court appointment documents for executor/administrator of estate

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QUESTIONS

If you have any questions, please contact the Benefits Specialist listed below. 

 

Benefits Specialist: 

Agency: 

Hours of Work (Eastern Time): 

Telephone Number, including extension: 

Email Address: 

Note: Additional information can be found on the U.S. Office of Personnel 

Management website: www.opm.gov . Most claim forms can be downloaded 

from this site. 

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