Form RI 25-7 RI 25-7 Marital Status Certification Survey; Revised June 2013

Form Approved
OMB Number 3206-0033

United States
Office of Personnel Management
Retirement Surveys and Students Branch
1900 E Street, NW, Room 2309
Washington, DC 20415-3562
Case Name

Claim Number

Date

(Show any address change next to your address.)

Marital Status Certification Survey
You MUST complete and return this form within 30 days after the date shown above. The form
MUST be signed and dated. Please also provide your daytime telephone number.
Please read the back of this form before completing. Check only the item that applies to you. Please enter the
month, day, and year in the space provided.
I have never remarried.
I remarried before I reached age 55 (this includes civil, religious and common law marriages).
The date of my remarriage is

Date (mm/dd/yyyy)

I remarried before I reached age 55. However, I was married to the person named above for a
full 30 years before his/her date of death. We were married on

Date (mm/dd/yyyy)

I remarried before I reached age 55 and this is my first time notifying OPM. This marriage has since ended. The
dates my remarriage began and ended are indicated below. Please provide a copy of the document showing the
date the marriage ended by death, divorce, or annulment.
Date of remarriage (mm/dd/yyyy)

Date the marriage ended (mm/dd/yyyy)

WARNING: We may verify your marital status through a computer match with other Federal agencies. Any
intentionally false or misleading statement, certification, or response you provide is a violation of the law punishable
by a fine of not more than $10,000 or imprisonment of not more than 5 years, or both (18 USC 1001).
I certify that all information provided on this form is true and correct to the best of my knowledge and belief.
Signature

Daytime telephone number

(

Date (mm/dd/yyyy)

Email address

)

Prior editions are not usable.

RI 25-7
Revised June 2013

Who Needs To Complete This Form?
You must complete and return this form in the envelope enclosed or complete the survey on-line or fax your response.

We contact you periodically to remind you of the eligibility requirements for you to continue receiving a survivor
annuity. By law, you may continue receiving this annuity only as long as you do not remarry before your 55th birthday
unless you were married to the decedent for at least 30 years before his or her death. If you remarried and that
marriage ended, please provide a copy of the document showing the date the marriage ended by death, divorce or
annulment. You are responsible for notifying us immediately of your remarriage. Failure to notify us immediately
will result in an overpayment of annuity. You will be held liable for all annuity paid to you after the remarriage.

How to Respond to This Survey
You may:
return this form to OPM in the enclosed return envelope, or
fax this form to (202) 606-0022 or (202) 606-2879.
The mailing address for Retirement Surveys and Student Branch is shown on the front of this survey form.

Information On Common Law (Mutual Consent Marriage)
If you live in a state that recognizes a common law (mutual consent) marriage, we must treat it the same as a marriage
by a civil or religious ceremony.

Need Help?
If you need help, please contact our Washington DC office at (202) 606-0249 or write to us at the address on the front
of this survey form. For general questions you can contact our Retirement Information Office toll free at
1-888-767-6738 from 7:30 AM to 7:45 PM, Eastern Time.

Privacy Act and Public Burden Statement
Information you furnish will be used to determine your eligibility to continue receiving survivor annuity payments. Information may be
shared and is subject to verification, via paper, electronic media, or through the use of computer matching programs, with national,
state, local, or other benefit paying agencies in order to determine and issue benefits under their programs, to obtain information
necessary for continuation of benefits under this program, or to report income for tax purposes. It may also be shared and verified,
as noted above, with law enforcement agencies when they are investigating a violation or potential violation of civil or criminal law.
Solicitation of this information is authorized by the Civil Service Retirement Law (Chapter 83, title 5 U.S. Code) and the Federal
Employees' Retirement Law (Chapter 84, title 5 U.S. Code). Failure to furnish the requested information may cause an overpayment
of annuity. We will have to collect any overpayment from you.

We estimate that providing this information takes an average 15 minutes per response, including the time for reviewing instructions,
getting the needed data, and reviewing the requested information. Send comments regarding our estimate or any other aspect of
this form, including suggestions for reducing completion time, to the United States Office of Personnel Management (OPM),
Retirement Services Publications Team (3206-0033), Washington, DC 20415-3430. The OMB number, 3206-0033, is currently valid.
OPM may not collect this information, and you are not required to respond, unless this number is displayed.

Reverse of RI 25-7
Revised June 2013