Ri 20-117 2016 Dc

United States
Office of Personnel Management
1900 E Street NW
Washington, DC 20415

Form approved
OMB Number: 3206-0174

Date
CSA No.

Important: Please Read This Entire Notice - As It Will Affect Your Annuity/Survivor Benefits.
You may elect a survivor annuity for a spouse you married after retirement. You must make your specific written
survivor election within 2 years of your marriage. Your election cannot be effective sooner than 9 months after your
marriage. Since you were not married at retirement, the election and reduction must be effective on the first day of
the month after the 9-month period beginning on the date of the marriage.
If you make this election, your annuity will be reduced to reflect the benefit payable to your spouse upon your death.
There will be two reductions in your annuity.
The first reduction is the regular cost of providing a survivor benefit and may be eliminated should your marriage
end.
The second reduction is permanent even if the marriage ends. This reduction is based on your age and on the amount
that your annuity would have been reduced to provide survivor benefits during any period(s) when it was not reduced
for an equal or greater survivor election, plus 6 percent interest compounded annually. Under the provisions of Public
Law 103-66, the only way to pay this amount is through an "actuarial" reduction in your annuity. This is called an
"actuarial" reduction because it is designed to spread the repayment out over the average life expectancy of a person
your age. There is no unpaid balance due after your death.
You were married on ________________ (mm/dd/yyyy); therefore, your election for a survivor benefit and the
reduction to provide this benefit is effective ________________ (mm/dd/yyyy). The current maximum survivor
benefit is $_________________.
As of the effective date, your gross monthly annuity is $_________________. The first reduction is
$_________________. The cost for any period(s) when your annuity was not reduced is $_________________,
and the actuarial reduction to pay it back is $_________________. Taken together the two reductions reduce your
gross monthly annuity to $____________.
If your annuity is not reduced by _________________ (mm/dd/yyyy), the excess annuity paid will result in an
overpayment. Therefore, it is to your advantage to return your specific written election to provide a survivor annuity
as soon as possible.

RI 20-117
Revised August 2016
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We computed the above costs assuming you want to elect the maximum possible benefit. You do have the option of
electing a smaller survivor annuity benefit, which would proportionately reduce the cost figures provided in this
letter. If you want to know the exact cost of a smaller benefit, enter the amount you would want your spouse to
receive each month on the enclosed request form. Return the request form to the following address: Office of
Personnel Management, Retirement Operations Center, Attn: PRM - STOP, PO Box 45, Boyers, PA 16017.
If you are requesting information on the cost for a smaller benefit, be sure to use the enclosed request form. An
election cannot be revoked or changed once we receive a valid survivor annuity election.
If you decide not to provide a survivor benefit for your spouse, you must complete the bottom portion of the enclosed
RI 20-63 and return it to our office before the second anniversary of your marriage.
If we have not received your specific written survivor election by the second anniversary of your marriage, your
request for survivor benefits will be dismissed.
If your marriage terminates and you want to provide a survivor benefit for a former spouse, you must file a specific
written election with OPM within 2 years after the date of termination of your marriage.
If we can be of further assistance, please let us know.
Sincerely,

Legal Administrative Specialist
(202) 606-_________________

Enclosure: RI 20-63 - Survivor Annuity Election for a Spouse

RI 20-117
Revised August 2016
Reverse of Page 1

Request Form

(Use this form to request cost information on electing less than the maximum survivor benefit.)
CSA No.

I am requesting cost information for a gross monthly survivor benefit of $____________________.
(Please specify a whole dollar amount [i.e. $25, $50, $75, $100] and sign and date below.)
Print your full name
Signature
Date

RI 20-117
Revised August 2016
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