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

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.

Latest Forms, Documents, and Supporting Material

Document Name
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All Historical Document Collections

202008-3206-001

Approved without change

New collection (Request for a new OMB Control Number)

2020-10-06