Application for Court-Ordered Benefits for Former Spouses, Standard Form 3119

OMB 3206-0275

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 can be found here.


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