Appendix A - Acceptable Forms with Electronic Signatures from 

Agencies and Payroll Officesi

Forms Certified by Agency Representatives Only

Form 

Number/Name

Number of 

Required 

Signatures

Agency 

and/or 

Payroll Office 

Signature

Other 

Signature 

(i.e., Notary, 

Financial 

Institution)

Special Requirements

SF 2806-1, Notice of 

Correction of Individual 

Retirement Record 

1 x 

Sent to OPM from 

Payroll Provider

SF 2810, FEHB Notice of 

Change in Health Benefits 

Enrollment 

1 x 

SF 2821, Agency 

Certification of Insurance 

Status (FEGLI) 

2 x 

There is no requirement 

that a certifying official 

cannot provide a 

facsimile signature

SF 3100, FERS Individual 

Retirement Record x 

No signature slot, 

normally stamped and 

sent electronically

Notification to OPM of 

Reemployment of 

Annuitant 

1 x 

Form must be 

completed and 

submitted to OPM 

according to the 

guidance on BAL 19-107

Notification to OPM of 

Separation of a 

Reemployed Annuitant - 

No Benefits Payable

1 x 

Form must be 

completed and 

submitted to OPM 

according to the 

guidance on BAL 19-107

RI 20-81, Request for 

Additional Information 1 x For OPM use only

RI 20-89, Verification of 

Military Retired Pay Status 1 x 

For OPM use only; form 

must be signed by 

Military Service 

retirement payroll 

providers
Form 

Number/Name

Number of 

Required 

Signatures

Agency 

and/or 

Payroll Office 

Signature

Other 

Signature 

(i.e., Notary, 

Financial 

Institution)

Special Requirements

RI 20-124, Certification of 

Service Performed as a Law 

Enforcement Officer, 

Firefighter, Nuclear 

Materials Courier, customs 

and Border Protection 

Officer (535 Service), or Air 

Traffic Controller

1 x 

Agencies must 

complete this form 

whenever an employee, 

who has performed 

service in one of these 

special provision 

categories, separates 

from the agency for any 

reason, including 

resignation, transfer, 

retirement (including 

disability retirement), 

and death

RI 38-133, Certification for 

Title 38 Physicians and 

Dentists of the Department 

of Veterans Affairs

1 x 

Only used for 

information on 

individuals receiving 

Special Pay under 

Chapter 74 of Title 38, 

U.S. Code

RI 79-08, Health Benefits 

Information Request 1 x For OPM use only

Forms Certified by both Applicants and Agency Representatives

Form 

Number/Name

Number of 

Required 

Signatures

Applicant

Signature

Agency 

and/or 

Payroll 

Office

Signature

Other 

Signature 

(i.e., Notary, 

Financial 

Institution)

Special 

Requirements

SF 2800A, CSRS 

Documentation and 

Elections in Support 

of Application for 

Death Benefits 

2 x x 
Form 

Number/Name

Number of 

Required 

Signatures

Applicant

Signature

Agency 

and/or 

Payroll 

Office

Signature

Other 

Signature 

(i.e., Notary, 

Financial 

Institution)

Special 

Requirements

SF 2801, CSRS 

Application for 

Immediate 

Retirement 

3 - 6 x x x 

The Spouse’s 

Consent to Survivor 

Election section of 

this form must be 

notarized and 

signed by the 

applicant's spouse 

when applicable; 

applicants may use 

remote/electronic 

notariesii

SF 2802, CSRS 

Application for 

Refund of 

Retirement 

Deductions 

2 - 4 x x x 

Certification from 

financial institution 

is required if 

rollover is elected; 

spouse/former 

spouse and witness 

signatures are 

required

SF 2804, CSRS 

Application to Make 

Voluntary 

Contributions

2 x x 

SF 2805, Request for 

Recovery of Debt 

Due to the United 

States 

2 x x 

SF 2809, FEHB 

Health Benefits 

Election Form

2 x x 

For Active Federal 

Employees only

SF 2817, Life 

Insurance Election 

(FEGLI)

2 x x 
Form 

Number/Name

Number of 

Required 

Signatures

Applicant 

Signature

Agency 

and/or 

Payroll 

Office 

Signature

Other 

Signature 

(i.e., Notary, 

Financial 

Institution)

Special 

Requirements

SF 2823, 

Designation of 

Beneficiary (FEGLI)

4 x x x 

Applicant may have 

two individuals 

witness their 

signature through a 

virtual 

environment; 

agency personnel 

may witness the 

execution of 

the SF 2823 as 

long as they are 

not named as 

beneficiaries

SF 3102, CSRS and 

FERS Designation of 

Beneficiary 

4 x x x 

Applicant may have 

two individuals 

witness their 

signature through a 

virtual 

environment; 

agency personnel 

may witness the 

execution of the SF 

3102 as long as 

they are not named 

as beneficiaries

SF 3104B, FERS 

Documentation and 

Elections in Support 

of Application for 

Death Benefits 

2 - 3 x x x 

Certification from 

financial institution 

is required if 

rollover is elected 

SF 3106, FERS 

Application for 

Refund of 

Retirement 

Deductions 

2 - 4 x x x 

Certification from 

financial institution 

is required if 

rollover is elected; 

spouse/former 

spouse and witness 

signatures are 

required
Form 

Number/Name

Number of 

Required 

Signatures

Applicant 

Signature

Agency 

and/or 

Payroll 

Office 

Signature

Other 

Signature 

(i.e., Notary, 

Financial 

Institution)

Special 

Requirements

SF 3107, FERS 

Application for 

Immediate 

Retirement 

3 - 6 x x 

The Spouse’s 

Consent to Survivor 

Election section of 

this form must be 

notarized and 

signed by the 

applicant's spouse 

when applicableapplicants may use 

remote/electronic 

notariesii

SF 3108, FERS 

Application to Make 

Service Credit 

Payment

3 x x

SF 3112, 

Documentation in 

Support of Disability 

Retirement 

Application 

3 x x x 

SF 3116, Phased 

Employment, 

Phased Retirement 

Status

2 x x 

FE-6 DEP, Statement 

of Claim, Option C 

(FEGLI)

2 x x 

Please see BAL 22-

203 for special 

submission 

requirements
List of Forms Certified by Applicants Only

Form 

Number/Name

Number of 

Required 

Signatures

Applicant 

Signature

Other 

Signature (i.e.,

Notary, Financial 

Institution)

Special Requirements

SF 2800, CSRS Application 

for Death Benefits 1 x 

SF 2818, Continuation of 

Life Insurance Coverage as 

an Annuitant or 

Compensationer (FEGLI)

1 x 

SF 2819, Notification of 

Conversion Privilege 

(FEGLI)

2 x x 

Please see BAL 22-203 for 

special submission 

requirements

SF 3104, FERS Application 

for Death Benefits 1 x 

RI 10-125, Federal 

Employee Retirement 

Coverage Corrections Act 

(FERCCA) Election Form

1 x 

RI 16-28, Authorization for 

Direct Payments 1 x 

RI 20-07, Representative 

Payee Application 2 x x 

Additional documentation 

may be necessary as 

required by RI 30-3,

Information Necessary for 

a Competency 

Determination 

RI 20-63, Survivor Annuity 

Election for a Spouse 1 x 

RI 20-64, Survivor Annuity 

Election for a Former 

Spouse 

2 x x 

Instructions for this form 

can be found on RI 20-

64B, Information on 

Electing a Survivor 

Annuity for Your Former 

Spouse (CSRS)
Form 

Number/Name

Number of 

Required 

Signatures

Applicant 

Signature

Other 

Signature (i.e., 

Notary, Financial 

Institution)

Special Requirements

RI 20-64A, Former Spouse 

Survivor Annuity Election 2 x x 

This form must be 

notarized and signed by 

the applicant's current 

spouse if retiree is 

married

RI 20-84, Civilian Deposit 

Election Letter 1 x For OPM use only

RI 20-97, Estimated 

Earnings During Military 

Service

1 x 

RI 25-14, Self-Certification 

of Full-Time School 

Attendance 

1 x 

RI 25-41, Initial 

Certification of Full-Time 

School Attendance 

1 x 

 

 

RI 25-51, CSRS Survivor 

Annuitant Express Pay 

Application for Death 

Benefits 

1 x 

 

 

RI 76-10, Assignment of 

Life Insurance (FEGLI) 3 x x 

Applicant may have two 

individuals witness their 

signature through a 

virtual environment; 

agency personnel may 

witness the execution of 

the RI 76-10 as long as 

they are not named as 

assignees

RI 76-15, Election to 

Convert Option C - Family 

Life Insurance

1 x For OPM use only

RI 79-9, Health Benefits

Cancellation or Suspension 2 x 

Confirmation

RI 92-19, Application for 

Deferred or Postponed 

Retirement 

1 - 4 x x 

Schedule A of this 

application must be 

notarized and signed by 

the applicant's spouse if 

applicable; applicants 

may use 

remote/electronic 

notariesii
Form 

Number/Name

Number of 

Required 

Signatures

Applicant 

Signature

Other 

Signature (i.e., 

Notary, Financial 

Institution)

Special Requirements

RI 92-25, Final Action for 

FERS Deposit and/or 

Redeposit Payment 

Election 

4 x For OPM use only

RI 94-07, Death Benefit 

Payment Rollover Election 3 x x 

For OPM use only; 

certification from financial 

institution is required if 

rollover is elected 

RI 98-07, Social Security 

Disability Benefits 

Information Request 

1 x 

 

For OPM use only

 

 

 

FE-6, Claim for Death 

Benefits (FEGLI) 1 x 

Please see BAL 22-203 for 

special submission 

requirements

OPM 1496, CSRS 

Application for Deferred 

Retirement

1 - 5 x x 

For separations before 

October 1, 1956, only; 

schedule B of this form 

must be notarized and 

signed by the applicant's 

spouse if applicable; 

applicants may use 

remote/electronic 

notariesii

OPM 1496A, CSRS 

Application for Deferred 

Retirement

1 - 4 x x 

For separations on or 

after October 1, 1956, 

only; schedule B of this 

form must be notarized 

and signed by the 

applicant's spouse if 

applicable; applicants 

may use 

remote/electronic 

notariesii

OPM 2809, Health Benefits 

Election Form 2 x x 

For annuitants, survivor 

annuitants, former 

spouses, or children and 

former spouses who are 

eligible for temporary 

continuation of coverage 

(TCC) use only; certified 

by OPM
i For more information on the Office of Management and Budget’s Regulatory Review of forms, please visit The Office of Information 

and Regulatory Affairs’ website. ii Applicants may use remote/electronic notaries. Visit The National Notary Association's website for more information and guidance on 

remote online notarization.