RI25-049 Verification of Full-Time School Attendance

OMB Approval 3206-0215

Verification of Full-Time
School Attendance

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

Claim number

For Agency Use Only

Show any address change next to your address below.
I

II

III

Student's name

Social Security Number

Certification Period

Date

IV

Please return the completed form to us within 30 days to avoid interruption of payments for the student.
The Office of Personnel Management is verifying the information you previously provided regarding the full-time attendance of the
student named above. We must be sure that benefits are properly paid and continued eligibility requirements are met. Please have the
verification form on the other side completed and signed by an official of the educational institution the student attended during the
certification period shown above. We request that the student complete Part A and sign the release of information statement below.
This will allow us to obtain any information we need from the school. Please return the completed form in the envelope provided to:
Office of Personnel Management, Retirement Surveys and Students Branch, 1900 E Street, NW, Washington DC 20415-0001 or fax
the form to (202) 606-0022. If the student named above has attended more than one school during the requested certification period,
you may duplicate the verification form for each school as necessary. Please call us at 1-888-767-6738 or (202) 606-0249 if you have
questions.
Part A (To be completed by the student)
1. Did you attend more than one school during the certification period shown above?
No
Yes
If yes, you must provide verification from each school.
You may photocopy this form as needed.
2. Do you intend to return to school for the next school year?
No
Yes
3. Estimated date of return, if you answered yes to question 2.

/
m

m

/
d

d

4. Student's Phone Number

(
y

y

y

-

)

y

5. I authorize the release of information about school attendance to OPM.
7. Date
6. Student's Signature
m

/
m

/
d

d

y

y

y

y

8. Email Address

Public Burden Statement
The public reporting burden to complete this information collection is estimated at 60 minutes per response, including time for reviewing instructions, searching data
sources, gathering and maintaining the data needed, and completing and reviewing the collected information. An agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden to the Office of Personnel Management, RS Publications Team at
[email protected]. Current information regarding this collection of information - including all background materials - can be found at https:/
www.reginfo.gov/public/do/PRAMain by using the search function to enter either Verification of Full-Time School Attendance or 3206-0215.
Previous editions are not usable

RI 25-49
Revised April 2024

Part B (To be completed by the school)

For greater accuracy in processing this form, please complete the questions in
a black felt tip or black ink pen.

This form must be completed and signed by an authorized school official. An authorized official of a high school is the principal, vice
principal, assistant principal or equivalent. Above the high school level, the form should be signed by the registrar, dean, administrator, or the
equivalent. At a technical or vocational school, the president, vice president, director, or the equivalent should sign.
1. Did ________________________________________ attend school full-time from ______________ to ______________?
name of the student

date (mm/dd/yyyy)

No, go to Item 2.

date (mm/dd/yyyy)

Yes, go to Item 3.

2. If the student attended school full-time for any period or periods during the school year being verified, please give the
beginning and ending date for each period.
First Period:
Beginning Date

/

m

m

Ending Date

/

d

d

/

y

y

y

m

y

/

m

d

d

y

y

y

y

y

y

y

y

Second Period, if any:
Beginning Date

/

m

m

Ending Date

/

d

d

/

y

y

y

m

y

/

m

d

d

3. Check the type of educational institution.
High School

University/College/Graduate School

Vocational/Trade/Technical

Other

4. Name of educational institution

5a. Street Address

5b. City

5c. State

6. Phone Number

(

)

5d. Zip Code

-

7. Date

-

/
m

m

/
d

d

y

y

y

y

I certify that all information given in this verification is true and correct to the best of my knowledge and belief. OPM may further verify the
information provided.

8. Signature of School Official

9. Email Address

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 by Civil Service Retirement Law (Chapter 83, title 5 U.S. Code), and the Federal Employees Retirement Law (Chapter 84, title 5,
U.S. Code). Purpose: OPM is requesting this information in order to ensure that benefits are properly paid and continued eligibility requirements are met regarding the full-time
attendance of the student listed on this form. Routine Uses: The information requested on this form may be shared externally as a "routine use" to other Federal agencies and thirdparties when it is necessary to process your request. 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 suitability, 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 systems 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 delay or prevent OPM from being able to properly administer benefits as
you would desire.
Reverse of RI 25-49
Revised April 2024