DD Form 2656-8, "SURVIVOR BENEFIT PLAN (SBP)/RESERVE COMPONENT SURVIVOR BENEFIT PLAN (RCSBP) - AUTOMATIC COVERAGE FACT SHEET"

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SURVIVOR BENEFIT PLAN (SBP)/RESERVE COMPONENT SURVIVOR BENEFIT PLAN (RCSBP) AUTOMATIC COVERAGE FACT SHEET
(Read instructions and Privacy Act Statement carefully before completing this form.)

OMB No. 0704 - 0569
OMB approval expires
08/31/2026

The public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing the burden, to the Department of War, Washington Headquarters Services, at [email protected]. Respondents should
be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB
control number.

PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. Chapter 71, Computation of Retired Pay; 10 U.S.C. 73, Annuities Based on Retired or Retainer Pay; DoD Instruction 1332.42, Survivor Benefit Plan; and DoD
Financial Management Regulation, 7000.14-R, Volume 7B; and E.O. 9397 (SSN), as amended.
PRINCIPAL PURPOSE(S): To determine military retirees marital and dependency status and all eligible family members to be listed as eligible beneficiaries under SBP/RSCSBP when
election was not received or invalid/missing information. Purpose is to correctly establish and maintain an accurate accounting of retired pay account for SBP/RCSBP.
ROUTINE USE(S): Disclosure of records are generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended. Pursuant to 5 U.S.C. 552a(b)(3), records may be
disclosed as a routine use to the Department of Veterans Affairs (DVA) regarding establishments, changes and discontinuing of DVA compensation to retirees and annuitants. To
former spouses for purposes of providing information, consistent with the requirements of 10 U.S.C. 1450(f)(3), regarding Survivor Benefit Plan coverage. To spouses for purposes of
providing information, consistent with the requirements of 10 U.S.C. 1448(a), regarding Survivor Benefit Plan coverage. A complete list of routine uses may be found in the applicable
System of Records Notice, T7347b, Defense Military Retiree and Annuity Pay System Records at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/
Article/570196/t7347b/ and DoD-0020, Military Human Resource Records at: https://www.federalregister.gov/documents/2024/05/15/2024-09967/privacy-act-of-1974-system-ofrecords.
DISCLOSURE: Voluntary; however, if the required information is not provided, your retired pay account may reflect incorrect SBP/RCSBP coverage and premium costs.

DEPENDENCY INFORMATION (To be completed by member)
1. MEMBER'S NAME (Last, First, Middle Initial)

2. SOCIAL SECURITY NUMBER

4. ARE YOU MARRIED?

5. DO YOU HAVE ANY DEPENDENT CHILDREN?

3. DATE OF BIRTH (YYYYMMDD)

NEEDS DD67

YES (Complete Item 6)

NO

b. SOCIAL SECURITY NUMBER

6.a. SPOUSE'S NAME (Last, First, Middle Initial)

d. DATE OF MARRIAGE (YYYYMMDD)

NO

YES (Complete Item 7)

c. DATE OF BIRTH (YYYYMMDD)

e. PLACE OF MARRIAGE (City, County, State)

7. I have the following dependent children under age 22 (or over age 22 and incapable of self-support because of being incapacitated before age 18, or
became incapacitated after age 18 but before age 22 while attending school).
a. NAME (Last, First, Middle Initial)

b. SSN

c. DATE OF
BIRTH
(YYYYMMDD)

d. RELATIONSHIP
(Son, daughter, stepson, etc.)

e. CHILD WITH
FORMER
SPOUSE

f. INCAPACITATED?
(Yes/No)

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

8. REMARKS

9. SIGNATURES
a. MEMBER
(1) NAME (Last, First, Middle Initial)

(2) SIGNATURE

(3) DATE (YYYYMMDD)

(2) SIGNATURE

(3) DATE (YYYYMMDD)

b. MEMBER'S WITNESS
(1) NAME (Last, First, Middle Initial)

(4) ADDRESS
(a) STREET (Include apartment number)

(b) CITY

DD FORM 2656-8, DRAFT 20260713
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(c) STATE

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(d) ZIP CODE

Controlled by: OUSW(P&R)
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POC: [email protected]

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INSTRUCTIONS
General
Public Law 92-425, effective September 21, 1972, provides that every member having a spouse and/or child(ren), who retired/transfers (reserve) on or after that
date is automatically covered under SBP/RCSBP at the maximum rate unless he/she elected otherwise before retirement or transfer.
On the date your retired/retainer pay account was established, one of two situations occurred: either we received no SBP/RCSBP election, or we received an
invalid SBP/RCSBP election. Therefore, we established your retired pay account with SBP/RCSBP coverage at the maximum rate, based either on Spouse-only
coverage or coverage based on dependents listed on your invalid SBP/RCSBP election.
Since Retired Pay Operations does not have complete information concerning your current marital status and dependents, the above SBP/RCSBP coverage may
or may not be correct. This is not an SBP/RCSBP election form. The purpose of this form is to obtain a listing of all eligible members of your family to be listed as
eligible beneficiaries under SBP/RCSBP.
Please complete and return this form to: Defense Finance and Accounting Service, U.S. Military Retirement Pay, 8899 E. 56th Street, Indianapolis, IN
46249-1200. or fax it to DFAS toll-free at 1-800-982-8459. If you have questions or need assistance completing this form, please contact DFAS toll-free at
1-800-321-1080. For USCG, NOAA, or USPHS accounts, e-mail the completed form to: [email protected] or mail to USCG/RAS, 444 SE Quincy
Street, Topeka, KS 66683-3591. If you have questions or need assistance, call 1-866-772-8724.
You are not required to provide this information, but failure to do so may result in incorrect SBP/RCSBP deductions from your retired pay and adjustments to your
survivor's annuity payments, or difficulty in establishing eligibility to receive future payments.

NEEDS DD67

If you did not have a spouse or dependent child(ren) as of the effective date of your entitlement to retired/retainer pay, or if before that date you either declined
SBP/RCSBP coverage or elected coverage before the effective date of your entitlement to retired/retainer pay, notify us immediately. Upon receipt of the original
copy of your election/declination, your account will be adjusted.
INSTRUCTIONS - DEPENDENCY INFORMATION - The following are to be completed by the member.
ITEMS 1 through 3. Provide your name, SSN, and date of birth.

ITEM 4. Indicate with an 'X' Yes or No to question: Are you married? If yes, complete Item 6.a. through e. and provide related information for spouse.
ITEM 5. Indicate with an 'X' Yes or No to question: Do you have any dependent children? If yes, complete Item 7.a. though f.
ITEMS 6.a through e. Provide your spouse's name, SSN, date of birth, date of marriage, and place of marriage. If no current spouse, enter "N/A" and proceed to
Item 7. If spouse does not have an SSN enter Taxpayer Identification Number (TIN) in Item 6.b. If no TIN, use a temporary SSN (usually all 3's or 9's) and add
comment to Item 8. Remarks. (Example: Item 6.b. SSN continued: Used temporary spouse SSN (all 3's) as placeholder due to not having an SSN or TIN at this
time.)
Note: Highly recommend spouse apply for a TIN with (IRS Form W-7) and contact DFAS once number is received to update the members records as soon as
possible to prevent loss of spouse benefits/pay in the event the member predeceases the spouse while still not having a TIN or SSN.
ITEMS 7.a. through f. Provide your child(ren)'s a. name(s), b. SSN(s), c. date(s) of birth. (YYYYMMDD), d. relationship (Son, daughter, stepson, etc.), mark with
an 'X' for e. child with former spouse, and for f. incapacitated (Y or N).
ITEM 8. Use the remarks section to continue an item or make additional comments. (Example: Item 7. Dependent Children continued.)
ITEM 9.a through b. Provide yours and witness signature and information, a.(1) NAME (Last, First, Middle Initial) (2) SIGNATURE (3) DATE (YYYMMDD), and
witness address.

DD FORM 2656-8, DRAFT 20260713
PREVIOUS EDITION IS OBSOLETE.

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