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pdfOMB Approval 3206-0142
Designation of Beneficiary
Civil Service
Retirement System
Important:
Read all instructions
before you use this form.
Civil Service Retirement System
A. Identification
Name (last, first, middle)
Place an "X" in the
block that applies
to you.
Date of birth (mm/dd/yyyy)
Social Security Number
An employee
Retired or an applicant for retirement
Former employee eligible for retirement in the future
If you are retired, give your claim
number.
CSA
Department or agency in which presently employed (or former department or agency):
Department or agency
Bureau
Division
I, the person identified above, designate the beneficiary or beneficiaries
named below to receive any lump-sum benefit which may become
payable under the Civil Service Retirement System (CSRS) after my
death. I understand that this designation of beneficiary will not affect
the rights of any survivors who may qualify for annuity benefits after my
death, cancels any previous designation of beneficiary, and remains in
effect until I cancel it in writing.
Location (city, state and ZIP code)
I direct, unless otherwise indicated below, that if more than one beneficiary is
named, the share of any beneficiary who may predecease me or who may be
disqualified for any other reason shall be distributed equally among the
stated beneficiaries or entirely to the survivor. If none of the beneficiaries are
alive and eligible to receive payment when a lump sum becomes payable,
this designation is void and payment will be made according to the order of
precedence set by law.
B. Information Concerning The Beneficiaries (See Examples on the reverse of Part 1. Type or print clearly.)
First name, middle initial, and
last name of each beneficiary n
Date of designation (mm/dd/yyyy)
Address (including ZIP code) of each beneficiary o
Relationship
to you n
Share to be
paid to each
beneficiary
Shares designated must
equal 100%.
Your signature
C. Witnesses (A witness is not eligible to receive payment as a beneficiary.)
We, the undersigned, certify that the person identified in A. above signed in our presence.
Signature of witness
Address (including ZIP code)
Signature of witness
Address (including ZIP code)
n We will pay to the person you designate, even if that person's name or relationship to you changes after you file this designation. For example, suppose you
designate your spouse and then you two divorce and you marry someone else. We will pay any lump sum to your former spouse unless you submit another
designation to cancel prior designations or to designate who we are to pay.
o We will write to the address you provide here to contact the person you designate. However, that person is obligated to get in touch with us after your death to
ask us to make payment.
Type or print your return address so that we can return a copy for your file.
Your designation is not effective until OPM receives and
certifies it. Mail both copies of your designation of
beneficiary to:
U.S. Office of Personnel Management
Retirement Operations Center
P.O. Box 45
Boyers, PA 16017-0045
U.S. Office of Personnel Management
5 CFR 831
Part 1 - Original
Standard Form 2808
Revised July 2020
The December 2008 revision is usable.
Important - The filing of this form will completely cancel any Civil Service Retirement System Designation of Beneficiary you may have filed
before this date. Be sure to name in this form all persons you wish to designate as beneficiaries of any lump sum payable at your death.
Examples
1. How to Designate One Beneficiary (Do not write names as M.E. Brown or as Mrs. John H. Brown. If you want to designate your
estate as beneficiary, enter "My estate" as the name of the beneficiary.)
First name, middle initial, and
last name of each beneficiary
Mary E. Brown
Address (including ZIP code) of each beneficiary
214 Central Avenue
Muncie, IN 47303
Relationship
to you
Niece
Share to be
paid to each
beneficiary
n 100 %
2. How to Designate More Than One Beneficiary (Be sure that the shares to be paid to the several beneficiaries add up to 100 percent.)
Address (including ZIP code) of each beneficiary
First name, middle initial, and
last name of each beneficiary
Relationship
to you
Share to be
paid to each
beneficiary
Alice M. Long
509 Canal Street
Red Bank, NJ 07701
Aunt
Joseph P. Brady
360 Williams Street
Red Bank, NJ 07701
Nephew
25 %
Catherine L. Rowe
792 Broadway
Whiting, IN 46394
Domestic
Partner
50 %
o 25 %
3. How to Designate A Contingency
First name, middle initial, and
last name of each beneficiary
John M. Parrish, if living
Otherwise to:
Susan A. Parrish
Address (including ZIP code) of each beneficiary
Relationship
to you
810 West 180th Street
New York, NY 10033
Father
810 West 180th Street
New York, NY 10033
Sister
Share to be
paid to each
beneficiary
n 100 %
100 %
4. How to Cancel and Effect Payment Under Order of Precedence (See back of duplicate)
First name, middle initial, and
last name of each beneficiary
Address (including ZIP code) of each beneficiary
Relationship
to you
Share to be
paid to each
beneficiary
Cancel prior designations
n "All" would also be acceptable.
o "One fourth," "one half," etc., would also be acceptable.
Standard Form 2808
Revised July 2020
Reverse of Part 1
OMB Approval 3206-0142
Designation of Beneficiary
Civil Service
Retirement System
Important:
Read all instructions
before you use this
Civil Service Retirement System
A. Identification
Name (last, first, middle)
Place an "X" in the
block that applies
to you.
Date of birth (mm/dd/yyyy)
Social Security Number
An employee
Retired or an applicant for retirement
Former employee eligible for retirement in the future
If you are retired, give your claim
number.
CSA
Department or agency in which presently employed (or former department or agency):
Department or agency
Bureau
Division
I, the person identified above, designate the beneficiary or beneficiaries
named below to receive any lump-sum benefit which may become
payable under the Civil Service Retirement System (CSRS) after my
death. I understand that this designation of beneficiary will not affect
the rights of any survivors who may qualify for annuity benefits after my
death, cancels any previous designation of beneficiary, and remains in
effect until I cancel it in writing.
Location (city, state and ZIP code)
I direct, unless otherwise indicated below, that if more than one beneficiary is
named, the share of any beneficiary who may predecease me or who may be
disqualified for any other reason shall be distributed equally among the
stated beneficiaries or entirely to the survivor. If none of the beneficiaries are
alive and eligible to receive payment when a lump sum becomes payable,
this designation is void and payment will be made according to the order of
precedence set by law.
B. Information Concerning The Beneficiaries (See Examples on the reverse of Part 1. Type or print clearly.)
First name, middle initial, and
last name of each beneficiary n
Date of designation (mm/dd/yyyy)
Address (including ZIP code) of each beneficiary o
Relationship
to you n
Share to be
paid to each
beneficiary
Shares designated must
equal 100%.
Your signature
C. Witnesses (A witness is not eligible to receive payment as a beneficiary.)
We, the undersigned, certify that the person identified in A. above signed in our presence.
Signature of witness
Address (including ZIP code)
Signature of witness
Address (including ZIP code)
n We will pay to the person you designate, even if that person's name or relationship to you changes after you file this designation. For example, suppose you
designate your spouse and then you two divorce and you marry someone else. We will pay any lump sum to your former spouse unless you submit another
designation to cancel prior designations or to designate who we are to pay.
o We will write to the address you provide here to contact the person you designate. However, that person is obligated to get in touch with us after your death to
ask us to make payment.
Type or print your return address so that we can return a copy for your file.
Your designation is not effective until OPM receives and
certifies it. Mail both copies of your designation of
beneficiary to:
U.S. Office of Personnel Management
Retirement Operations Center
P.O. Box 45
Boyers, PA 16017-0045
U.S. Office of Personnel Management
5 CFR 831
Part 2 - Duplicate
Standard Form 2808
Revised July 2020
The December 2008 revision is usable.
Instructions
Use this form ONLY if you are or were covered by the Civil Service Retirement System. If any portion of your service was under the Federal Employees'
Retirement System, use Standard Form (SF) 3102. This Designation of Beneficiary form is used to designate who is to receive a lump-sum payment which may
become payable after your death. It does not affect the right of any person who is eligible for survivor annuity benefits. Do not confuse this form with designation
forms used for other types of benefits: SF 2823, Designation of Beneficiary, Federal Employees' Group Life Insurance Program; SF 3102, Designation of
Beneficiary, Federal Employees' Retirement System; TSP-3, Federal Retirement Thrift Savings Plan Designation of Beneficiary; or SF 1152, Designation of
Beneficiary, Unpaid Compensation of Deceased Civilian Employee.
Do not fill out this form until you have read the information and instructions below.
Important - The filing of this form will completely cancel any Designation of Beneficiary under the Civil Service Retirement System you may have previously filed.
Be sure to name in this form all persons you wish to designate as beneficiaries of any lump sum payable at your death.
Order of Precedence
4.
You do not need to make a designation if you are satisfied with the order of
precedence the law provides and you do not have a certified designation on
file. That order of precedence follows:
A witness to a designation of beneficiary is not eligible to receive
payment as a beneficiary.
5.
You cannot change or cancel a designation of beneficiary in a letter or
in a last will or testament unless it is signed, witnessed, and filed as
described in paragraph 3.
6.
A designation of beneficiary remains in effect until (1) you cancel it by
filing a new designation or (2) you receive a refund of your retirement
deductions before retirement. To inform us if the name or address of a
beneficiary changes, file a new designation of beneficiary. It may be
important to file a new designation if your family situation changes.
1.
To your widow or widower.
2.
If your widow(er) is deceased, to your child or children, with the share
of any deceased child distributed equally among the descendants of
that child.
3.
If none of the above, to your parents in equal shares or the entire
amount to the surviving parent.
4.
If none of the above, to the executor or administrator of your estate.
5.
If none of the above, to the next of kin under the laws of the State in
which you live at the time of your death.
Completing the Designation Form
1.
The examples printed on the back of the first page of this form may be
helpful to you in naming a beneficiary or canceling a prior designation
of beneficiary.
Payment of a lump sum will be made to the first person or persons listed
above who are alive on the day you die.
2.
If you designate more than one beneficiary, be sure that the shares
to be paid add up to 100 percent. Do not use dollar amounts to
indicate the shares.
Designating a Beneficiary
3.
If you wish to designate more than four persons in Part B, use a blank
sheet of paper which you will attach to the form. Print your name and
date of birth at the top of the attachment and provide the information
required in Part B for each beneficiary. Your signatures on the form
and on the attachment must be witnessed by the same two people.
The witnesses must sign both the form and the attachment.
4.
Complete the form in duplicate. Type or print all entries except
signatures.
5.
Do not erase or alter entries.
1.
You can designate any person, firm, corporation, or legal entity as your
beneficiary.
2.
You can change your beneficiary at any time, without the knowledge or
consent of a previous beneficiary, and this right cannot be waived or
restricted.
3.
A designation of beneficiary must be in writing, signed, and witnessed.
To be valid the designation must be received and certified by the
Office of Personnel Management before your death.
Privacy Act Statement
Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement serves to inform you of why OPM is requesting the information on this form. Authority: OPM is
authorized to collect the information requested on this form pursuant to Title 5, U. S. Code, Chapter 83, Section 8342, which, provides that a Federal employee
or an annuitant may designate a beneficiary to receive the lump sum payment due from the Civil Service Retirement System (CSRS) in the event of death. OPM
is authorized to collect your Social Security number by Executive Order 9397 (November 22, 1943), as amended by Executive Order 13478 (November 18, 2008).
Purpose: OPM is requesting this information to determine the proper payee after the respondent's death. Routine Uses: The information requested on this form
may be shared as a "routine use" to other Federal agencies and third-parties when it is necessary to process your application. For example, OPM may share your
information with other Federal, state, or local agencies and organizations in order to determine benefits under their programs, to obtain information necessary for
a determination of your disability retirement benefits, or to report income for tax purposes. OPM may also share your information with law enforcement agencies if
it becomes aware of a violation or potential violation of civil or criminal law. A complete list of the routine uses can be found in the OPM/CENTRAL 1 Civil Service
Retirement and Insurance Records system of records notice, available at www.opm.gov/privacy. Consequences of Failure to Provide Information: Providing
this information is voluntary. However, failure to provide this information may result in the noncompliance of the provisions of title 5, U.S.C, Chapter 83. Individuals
who do not provide this information can also request changes via telephone or letter, as well as using SF 2808. The information collected can only be obtained
from the respondents.
Public Burden Statement
We estimate providing this information takes an average of 15 minutes per response to complete, including the time for reviewing instructions, getting the needed
data, and reviewing the completed form. Send comments regarding our estimate or any other aspect of SF 2808, including suggestions for reducing completion
time, to the Office of Personnel Management (OPM), Retirement Services Publications Team (3206-0142), Washington, D.C. 20415-0001. The OMB number
3206-0142 is currently valid. OPM may not collect this information, and you are not required to respond, unless this number is displayed.
Standard Form 2808
Revised July 2020
Reverse of Part 2
| File Type | application/pdf |
| File Title | Printing H:\FORMFLOW\SF2808.FRP |
| Author | csbenson |
| File Modified | 2020-01-16 |
| File Created | 2011-09-15 |