Federal employees use this form to enroll or to cancel life insurance coverage. New Federal employees in eligible positions are automatically covered by Basic insurance and do not need to use this form if they want only the Basic coverage. Annuitants do not use this form.
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.