Information and Instructions on Your Reconsideration Rights

United States
Office of Personnel Management
Retirement Operations

Form Approved:
OMB No. 3206-0237

Information and Instructions on Your Reconsideration Rights
I. Information

II. Procedures

Reconsideration is OPM’s review of its initial decision in
order to verify that all applicable laws and regulations were
properly applied.

The procedures for requesting reconsideration — as
established by Federal regulation — are as follows:

This notice gives specific instructions on how you may
request reconsideration of an initial decision made by
OPM’s Retirement Services in any case where the decision:

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Affects your rights or interests under the Civil Service
Retirement System or under the Federal Employees’
Retirement System, except in matters pertaining to disability
retirement and annuity overpayments. Different instructions
apply to these exceptions; see below for more information.
(5 C.F.R., Part 831 and 841)
Denies you basic or optional life insurance coverage
under the Federal Employees’ Group Life Insurance
Program or denies you the right to change your
post-retirement basic life insurance coverage after
retirement. (5 C.F.R., Parts 870, 871, 872, and 873)

Denies your request to permit coverage of someone as a
family member under the Federal or Retired Federal
Employees Health Benefits Program.
(5 C.F.R., Parts 890 and 891)

These instructions do not apply to:
Decisions concerning a disability retirement eligibility.

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Initial decisions under 5 U.S.C. 8336(c) regarding law
enforcement or firefighter eligibility.

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B. Your written request for reconsideration must be
received by OPM within 30 calendar days from the date of
OPM’s initial decision. (OPM can extend the time limit if
you can show that you (1) were not notified of the time limit
and were not otherwise aware of it or (2) were prevented
from responding by a cause beyond your control.)
C. Send your request for reconsideration to:

Denies your request to enroll or change enrollment in the
Federal or Retired Federal Employees Health
Benefits Program. (5 C.F.R., Parts 890 and 891)

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A. Make your request in writing and state that you are
requesting reconsideration; if possible, include a copy of the
initial decision on which your request is based. Include your
name, address, date of birth, claim number (if applicable),
name of the health insurance plan (if applicable), and your
reason(s) for the request.

Office of Personnel Management
Legal Reconsideration Branch, Room 3468
1900 E Street NW
Washington, DC 20415-3550
If you plan to submit additional evidence to support your claim
and that evidence is not immediately available, you must:

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Submit a written request for reconsideration within the
30-day time limit; and

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Include in your request for reconsideration a statement that
you will be submitting additional evidence, a brief
description of the evidence you will submit, your estimate of
the date the evidence will be available, and a brief
explanation for the delay.

We will acknowledge receipt of your statement and let you know
the date after which additional submissions will not be accepted.

Decisions to collect an annuity overpayment.
Where applicable, OPM will give you separate specific
instructions and information in the above instances.

III. Final Decision

Requests for reconsideration of claims denied by your
health insurance carrier should be sent to the address
shown in the brochure of your plan.

After reviewing our initial decision and any new evidence that
has been submitted, OPM will send you a final decision in
writing. We will send copies of that decision to any competing
claimants or to your employing office, if applicable.

If you want general information about benefits or a written
decision on another matter, you should write to:

Public Burden Statement
We estimate this form takes an average 45 minutes per response
to complete, including the time for reviewing instructions,
getting the needed data, and writing the request for
reconsideration. Send comments regarding our estimate or any
other aspect of this form, including suggestions for reducing
response time, to the Office of Personnel Management (OPM),
Retirement Services Publications Team (3206-0237),
Washington, DC 20415-3430. The OMB Number, 3206-0237, is
currently valid. OPM may not collect this information, and you
are not required to respond, unless this number is displayed.

Office of Personnel Management

Retirement Operations Center

P.O. Box 45

Boyers, PA 16017-0045

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RI 38-47
Revised July 2011