Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits

OMB 3206-0233

RI 25-51 will be used by the Civil Service Retirement System solely to pay benefits to the widow(er) of an annuitant. This application is intended for use in immediately authorizing payments to an annuitant's widow or widower, based on the report of death, when our records show the decedent elected to provide benefits for the applicant. The Privacy Act Statement has been revised due to a systematic review by our Chief Privacy Officer.

The latest form for Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits expires 2023-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form RI 25-51 Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits Form and Instruction
E8-5659.pdf Supplementary Document
RI25-051_2011-05_MarkUp.pdf Supplementary Document
RI25-051_60DayFRN_Published_2020_03_23.pdf Supplementary Document
RI25-051_30DayFRN_Published_2020_08_19.pdf Supplementary Document
RI25-051_OMB_Support_Stmt_2020.docx Supporting Statement A
Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits Form and Instruction

All Historical Document Collections

202010-3206-012 Approved without change	Revision of a currently approved collection	2020-10-16
201701-3206-005 Approved without change	Reinstatement without change of a previously approved collection	2017-05-15
201402-3206-002 Approved without change	Extension without change of a currently approved collection	2014-02-18
201106-3206-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2011-06-06
201010-3206-006 Approved without change	Revision of a currently approved collection	2010-11-02
200711-3206-004 Approved without change	Extension without change of a currently approved collection	2007-11-09
200410-3206-002 Approved without change	Revision of a currently approved collection	2004-10-08
200107-3206-003 Approved without change	Revision of a currently approved collection	2001-07-13
199804-3206-006 Approved without change	New collection (Request for a new OMB Control Number)	1998-04-24