OMB control number
Application for Court-Ordered Benefits for Former Spouses, Standard Form 3119
OMB 3206-0275 · OPM.
OMB 3206-0275
5 CFR 838.221, 838.421, and 838.721 require former spouses of Federal employees to write to OPM, providing specific information needed for OPM to make court-ordered benefit payments. This information is needed to identify affected employees and to certify that the court order remains in effect.
The latest form for Application for Court-Ordered Benefits for Former Spouses, Standard Form 3119 expires 2023-11-30 and is listed under ICR 202008-3206-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form Standard Form 3119 Application for Court-Ordered Benefits for Former Spouses | Form and Instruction |
| E8-5659.pdf | Supplementary Document |
| ARS PIA Final 12212017signed.pdf | Supplementary Document |
| 2020-15455.pdf | Supplementary Document |
| SF3119_60DayFRNPublished_2020_03_23.pdf | Supplementary Document |
 SF3119_OMBSupportingStatement_2020_06_18.docx | Supporting Statement A |
 Application for Court-Ordered Benefits for Former Spouses |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202008-3206-001 | New collection (Request for a new OMB Control Number) | 2020-10-06 | Approved without change |