RI 25-15_MarkUp Current Version

OMB Approval 3206-0042

Notice of Change in
Student's Status
Show any address change next to your address below.

U.S. Office of Personnel Management
Retirement Surveys & Students Branch 1900 E
Street, NW
Washington, DC 20415-0001

Claim number

For Agency Use Only
I

Date

II

III

IV

Student's name

Inserted text regarding the
hearing impaired.

You have been receiving student survivor benefits for the student shown above based on self-certification of full-time
attendance that you provided to the Office of Personnel Management (OPM) covering all or part of the current school
year. This form is being sent to assist you in notifying OPM about events that affect eligibility to receive student
benefits. Only return this form if the student's status has changed. This precoded form that can only be used for
the student shown above. If the student's status has changed, please return this form in the enclosed envelope or
fax it to (202) 606-0022. If you have any questions about this form, you can call our office at (202) 606-0249.
Individuals residing outside the Washington DC area can call our Retirement Information Office toll free at
1-888-767-6738. You can also write to OPM at the address shown above.
If any of the events shown in number 1 apply, fill in the appropriate oval. Please write the month, day, and year that the event
occurred or will occur inside the boxes provided in number 2. You should enter a leading zero for months and days with a
single number, for example, March 3, 2006, would be 03/03/2006.
1. Events
Reduced attendance to less than full-time
Stopped school attendance (other than for regularly scheduled school breaks)
Married
Deceased
Entered military service on active duty
Entered a U.S. military academy
Transferred to a non-recognized school
2. Date of Event:

/
Warning:

/

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 U.S.C. 1001).

I certify that all of the information given on this form is true and correct to the best of my knowledge and belief.
Payee's signature

Student's signature

Previous editions are not usable

Daytime telephone number

Email address

Date (mm/dd/yyyy)

RI 25-15
Revised August 2018

Information For Completing The Notice of Change In Student's Status
Eligibility Information
Survivor benefits can be paid to children of deceased Federal employees and retirees. The children must be between
the ages of 18 and 22, unmarried, and full-time students in a recognized school. Full-time students must have a
sufficient subject load to allow them to graduate within the minimum time that is considered normal for a full-time
day student of the school. Generally, at a college or university, you must be enrolled for a minimum of 12 credit hours
per semester to be considered a full-time student. If you carry fewer than 12 credit hours at any time during the school
year but believe that school attendance was full-time, please send us a letter from the school stating whether the
school considers it full-time.
A recognized school is non-correspondence institution of learning, high school, or above, that has a faculty and
requires that study or training be accomplished on its premises. Included are high schools that are licensed by the
state, and trade schools, colleges, and universities that are accredited by nationally recognized accrediting agencies.
Not included as "recognized" for purposes of receiving student benefits are: elementary schools, correspondence
schools, U.S. Military Academies, such as the U.S. Naval Academy, or any training program where a trainee receives
pay primarily as an employee (e.g., an apprenticeship training program).

Benefits (payments) must stop if the student:
1. reduces school attendance to less than full-time,
2. stops school attendance,
3. marries,
4. dies,
5. enters military service on active duty,
6. enters any of the U.S. military academies, or
7. transfers to a non-recognized school.
Students who attain age 22 during the school year (between September 1 and June 30) may receive benefits through
the end of the month preceding the month in which full-time schooling stops or June 30, whichever occurs first.
Notify OPM immediately if any of these events occurs. If you are paid benefits after any of these events, you have
been overpaid and we will have to recover the money from you.

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 RI 25-15 pursuant to Title 5, U. S. Code, Chapter 83, Section 8341(a)(4)
and Chapter 84, Section 8441(4), which discuss the continuing eligibility of unmarried, dependent student children between the ages of 18
and 22 to receive survivor annuity benefits. Purpose: This form is used to to collect information from students regarding marital status,
current and future plans for full-time school attendance and to verify that the student has continued the school attendance previously certified.
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: If OPM could not collect this information, benefits would be paid to persons who are no longer entitled.
Public Burden Statement
We estimate that providing this information takes an average 20 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 U.S. Office of Personnel Management, CRIS Publications Team, (3206-0042), Washington,
DC 20415- 0001. The OMB Number, 3206-0042, is currently valid. OPM may not collect this information, and you are not required to
respond, unless the number is displayed.
Reverse of RI 25-15
Revised August 2018