Click here to skip navigation
This website uses features which update page content based on user actions. If you are using assistive technology to view web content, please ensure your settings allow for the page content to update after initial load (this is sometimes called "forms mode"). Additionally, if you are using assistive technology and would like to be notified of items via alert boxes, please follow this link to enable alert boxes for your session profile.
OPM.gov Home  |  Subject Index  |  Important Links  |  Contact Us  |  Help

U.S. Office of Personnel Management - Recruiting, Retaining and Honoring a World-Class Workforce to Serve the American People


Advanced Search

This page can be found on the web at the following url:
http://www.opm.gov/insure/life/fegli/sf2821.asp

Insurance Programs

  1. New / Prospective Employees
  1. Federal Employees
  1. Retirees / Survivors
  1. Benefits Officers
Skip Left-NavigationSkip Navigation

Life

Agency Certification of Insurance Status

SF 2821
May 1995

Use:

Agencies complete this form when an employee's life insurance stops or is scheduled to stop, except when the employee voluntarily cancels coverage, or the employee is immediately transferring to another position which will provide eligibility for FEGLI insurance coverage.


Electronic Copies:

PDF Fillable Version Adobe Acrobat Version [102 KB]


Paper Copies:
Employees:

Will receive a copy of the completed form from their servicing Human Resources Office, when applicable.

Agencies:

Use your internal agency procedures for ordering Standard Forms. Paper copies of this form are NOT available from OPM.