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

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 2022-11-30 and can be found here.

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Extension without change of a currently approved collection 2022-11-18
Approved without change
No material or nonsubstantive change to a currently approved collection 2022-03-08
Approved with change
Revision of a currently approved collection 2019-09-03
Approved with change
Revision of a currently approved collection 2015-09-11
Approved without change
Revision of a currently approved collection 2012-08-27
Approved without change
No material or nonsubstantive change to a currently approved collection 2012-01-26
Approved without change
Revision of a currently approved collection 2010-06-23
Approved with change
Extension without change of a currently approved collection 2007-04-24
Approved without change
Revision of a currently approved collection 2004-02-23
Approved without change
Revision of a currently approved collection 2000-09-20
Approved without change
Revision of a currently approved collection 1998-10-23
Approved without change
Revision of a currently approved collection 1995-07-20
Approved without change
Revision of a currently approved collection 1994-06-30
Approved with change
No material or nonsubstantive change to a currently approved collection 1991-10-24
Approved without change
Revision of a currently approved collection 1991-03-12
Approved without change
Revision of a currently approved collection 1990-06-28
Approved with change
No material or nonsubstantive change to a currently approved collection 1989-03-07
Approved without change
Extension without change of a currently approved collection 1987-06-23
Approved without change
New collection (Request for a new OMB Control Number) 1987-04-06

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