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U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

Insurance Services Programs

FEGLI Program Booklet For Federal Employees

Life Insurance Forms

Unless otherwise noted, the following life insurance forms and publications are available at www.opm.gov/insure/life. You may also wish to check with your human resources office. Some agencies have automated versions of some of these forms.

Standard Forms

SF 2817	Life Insurance Election
SF 2818	Continuation of Life Insurance Coverage As an Annuitant or Compensationer
SF 2819	Notice of Conversion Privilege
SF 2820	Certification of Insured Employee's Retired Status
SF 2821	Agency Certification of Insurance Status
SF 2822*	Request for Insurance
SF 2823	Designation of Beneficiary

Office of Personnel Management Forms

OPM 1482	Agency Certification of Status of Reemployed Annuitants
RI 76-10	Assignment, Federal Employees' Group Life Insurance

Office of Federal Employees' Group Life Insurance Forms

FE-6	Claim for Death Benefits
FE-6DEP	Statement of Claim — Option C
FE-7	Claim for Accidental Dismemberment
FE-8†	Claim for Living Benefits

Booklets, Pamphlets, and Handbooks

RI 76-12	FEGLI Pamphlet for Retirees
FE 76-20	FEGLI Program Booklet (U.S. Postal Service)
FE 76-21	FEGLI Program Booklet (Federal)
RI 76-26*	FEGLI Handbook

* Available in electronic format only at www.opm.gov/insure/life.

† Available only from the Office of Federal Employees' Group Life Insurance (OFEGLI) by calling 1-800-633-4542.

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