FEGLI enrollees and assignees use this form to designate who should receive the death benefits. NOT required if the enrollee or assignee has not filed a previous designation of beneficiary and is satisfied with the standard order of precedence.
Attachments are also available for designating a trust — Inter vivos Format | Testamentary Format | Instructions
Electronic Copies:
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To use the Adobe Acrobat forms you need the commercial Acrobat software or the free downloadable Acrobat Reader. You can fill in this form on your computer screen before you print it.
 
The FormFlow version is provided for those agencies that use this commercial forms software. |
Employees:
Request a paper copy of this form from your servicing Human Resources Office.Annuitants or Assignees:
- Call toll free 1-888-767-6738 (202-606-0500 in the DC Area), or
- Send an email to retire@opm.gov, giving the number of the form that you need and your mailing address, or
- Request a copy from a local Federal agency Human Relations Office.
Use your internal agency procedures for ordering Standard Forms.Paper copies of this form are NOT available from OPM.