OMB control number
Application for Death Benefits (FERS)/Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death (FERS)
OMB 3206-0172 · OPM.
OMB 3206-0172
SF 3104, Application for Death Benefits (FERS), is used by persons applying for death benefits which may be payable under FERS because of the death of an employee, former employee, or retiree who was covered by FERS at the time of his/her death or separation from Federal Service. SF 3104B, Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death, is used by applicants for death benefits under FERS if the deceased was a Federal employee at the time of death.
The latest form for Application for Death Benefits (FERS)/Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death (FERS) expires 2027-02-28 and is listed under ICR 202211-3206-003.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form Standard Form 3104 Application for Death Benefits (FERS); Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death | Form and Instruction |
 SF3104_OMB_Supporting_Stmt_2022_4_19.docx | Supporting Statement A |
| FACES 2017 FINAL 12212017signed.pdf | Supplementary Document |
| ARS PIA Final 12212017signed.pdf | Supplementary Document |
| SF3104_30DayFRNPublished_2022_08_24.PDF | Supplementary Document |
| SF3104_60DAYFRN_Published_2022_02_18.pdf | Supplementary Document |
 Application for Death Benefits (FERS); Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death |
Form and Instruction |