Federal employees who are retiring or receiving compensation payments use this form to indicate their choices for continuing their life insurance coverage.
Download the form locally or request a downloaded copy from your servicing Human Resources Office.
Paper copies of this form are not available. You must use the downloadable Adobe Acrobat PDF version posted here. Previous versions are NOT usable.
If individual agencies need a published version for their forms stock, they can download the PDF file and submit a printing request to the Government Printing Office.