INSTRUCTIONS: The Insured or assignee must sign this form. Two people must witness the signature and sign as witnesses. The Insured's agency (or U.S. Office of
Personnel Management [OPM], if the Insured is an annuitant or insured as a compensationer) must receive the designation before the Insured's death. A person with a power
of attorney or other similar legal authority may not sign for the Insured or assignee. A witness cannot be a beneficiary. The agency or OPM, as appropriate, must receive valid
court orders involving FEGLI before the Insured's death.
Please read the additional instructions below before completing this form.
"You" and "your" refer to the person completing this form (the Insured or an assignee). The "Insured" is the insured employee, annuitant or
compensationer. The "Assignee" is a person(s), firm(s), or trust(s) (usually named on an Assignment form, RI 76-10) who owns and controls the
Insured's life insurance coverage. An assignment is NOT the same as a designation of beneficiary.
Who receives benefits when the Insured dies? By law, the Office of Federal
Employees' Group Life Insurance (OFEGLI) pays benefits in this order:
If the Insured assigned ownership of his/her insurance (usually by filing an
RI 76-10, Assignment of Life Insurance), OFEGLI will pay:
First, to the beneficiary(ies) the assignee(s) validly designated;
Second, if none, to the assignee(s).
If the Insured did not assign ownership and there is a valid court order (see
Part 870 of title 5, Code of Federal Regulations) on file with the agency or
OPM, as appropriate, OFEGLI will pay benefits according to the court order.
If the Insured did not assign ownership and there is no valid court order on file
with the agency or OPM, as appropriate, then OFEGLI will pay:
First, to the beneficiary(ies) the Insured validly designated;
Second, if none, to the Insured's widow or widower;
Third, if none of the above, to the Insured's child or children in equal
shares, and the descendants of any deceased children (a court will usually
have to appoint a guardian to receive payment for a minor child);
Fourth, if none of the above, to the Insured's parents in equal shares, or
the entire amount to the surviving parent;
Fifth, if none of the above, to the court-appointed executor or
administrator of the Insured's estate;
Sixth, if none of the above, to the Insured's other next of kin entitled
under the laws of the State where the Insured lived.
Do I have to designate a beneficiary? No. But if you want OFEGLI to pay
differently than listed above and you have not assigned the life insurance and there
is no valid court order on file with the agency or OPM, as appropriate, you need to
designate a beneficiary.
What if one of the beneficiaries dies or is disqualified for any reason? Unless
you indicate otherwise on your designation of beneficiary, OFEGLI will distribute
that beneficiary's share equally among the surviving beneficiaries, or entirely to the
sole survivor.
What if none of the beneficiaries is living when the Insured dies? OFEGLI will
pay the benefits according to the order of precedence listed above.
Can I cancel or change this designation at any time? Yes, you may cancel or
change your designation at any time, without the knowledge of or consent of the
beneficiary(ies), unless you assigned the insurance or there is a valid court order
contingent and your beneficiary does not live long enough to qualify, OFEGLI will
pay according to the order listed in the first column.
Can I designate a trust? Yes. See examples 5 and 6 on the Back of Part 1. Those
examples name a contingent beneficiary in case the trust is not valid. You don't
have to name a contingent beneficiary unless you want to. If the trust is not valid,
and you do not name a contingent, OFEGLI will pay according to the order listed in
the first column. The trust designation should include the name of the grantor, the
trust name (if different), the name(s) of the trustees, and the date the trust was
signed.
When is a designation canceled? A designation of beneficiary is automatically
canceled 31 days after the Insured stops being insured. It is also canceled if either
the Insured or assignee assigns the insurance or if the Insured or assignee submits
another valid designation.
What if the Insured elected a full living benefit? Then there is no Basic left. So
if you want to designate different types of insurance to different beneficiaries (see
example 4 on the Back of Part 1), you should only list Option A and Option B.
Who can sign this form? The Insured or Assignee (if applicable) must sign this
form. The signature of a guardian, conservator or other fiduciary (including, but not
limited to, those acting according to a Power of Attorney or a Durable Power of
Attorney) is not acceptable.
What if I erase or cross out something on this form? You should complete
another form. Erasures, cross-outs and alterations cause a delay in the payment of
benefits and may make the entire designation invalid.
What if I need more room? Write "See Attached" in Part B of the form. Use a
blank sheet. Print your name, date of birth and social security number at the top of
the attachment. List the information required in Part B for each beneficiary. Sign the
form and attachment. Have the same two people witness both of your signatures and
sign the form and attachment.
Where can I get more information? The FEGLI Handbook (RI 76-26) and FEGLI
Booklet (FE 76-21 or FE 76-20 for Postal employees) contain more information.
You can read them at www.opm.gov/healthcare-insurance/life-insurance.
Where should I send this form? Send it to the Insured's employing agency if the
Insured:
on file with the agency or OPM, as appropriate.
Is a change or cancellation of beneficiary in my last will or testament valid?
is an employee; or
has been receiving compensation payments from the Office of Workers'
Compensation Programs for less than 12 months and is still on the agency's
It is valid only if you sign your will, two people who witnessed your signature sign
your will, and your agency (or OPM, for retirees or insured compensationers)
rolls as an employee.
receives your will before the Insured's death.
Send it to the Office of Personnel Management, Retirement Operations Center, P.O.
What if I don't know a beneficiary's social security number? If you don't know
Box 45, Boyers, PA 16017-0045 if the Insured:
the number, leave it blank. But having the number helps speed up the payment of
benefits.
is a retiree; or
is receiving compensation payments from the Office of Workers'
Compensation Programs and is not still employed or has been receiving
Can a witness receive benefits as a designated beneficiary? No.
compensation payments for at least 12 months.
Who can I name as a beneficiary? You may name any person, firm, corporation or
legal entity (except an agency of the Federal or District of Columbia government).
Can I use a common disaster clause? Yes. A common disaster clause is a
statement that says that a designated beneficiary is entitled to the benefits only if
he/she survives the Insured by a specified minimum number of days. The number of
days cannot exceed 30. You can name a contingent beneficiary. If you don't name a
The agency or OPM will note receipt in section E of the form and return a copy to
you as evidence that it received and filed the original.
PROPERLY COMPLETED DESIGNATIONS ARE NOT VALID UNLESS
THE APPROPRIATE OFFICE LISTED ABOVE RECEIVES THEM
BEFORE THE INSURED'S DEATH.
Privacy Act and Public Burden Statements
Title 5, U.S. Code, chapter 87, Life Insurance, authorizes solicitation of this information. The
Executive Order 9397, dated November 22, 1943, allows Federal agencies to use the Social
Office of Federal Employees' Group Life Insurance (OFEGLI) will use the information you
Security Number as an individual identifier to distinguish between people with the same or
furnish to determine your beneficiary(ies) for benefits under the Federal Employees' Group
similar names.
Life Insurance Program. OFEGLI is not a Federal agency. It is staffed by employees of the
contracted life insurance carrier. It may share this information with the Office of Personnel
While the law does not require you to supply all the information requested on this form, doing
Management (OPM). Agencies and/or OPM will place this information in the Insured's Official
so will help in the prompt processing of your designation.
Personnel Folder or retirement file. OPM or OFEGLI may disclose this information to other
Agencies other than the Office of Personnel Management may have further routine uses for
Federal agencies or Congressional offices which may have a need to know it in connection
disclosure of information from the records systems in which they file copies of this form. If this
with your application for a job, license, grant or other benefit. It may also be shared and is
is the case, they should provide you with any such uses which are applicable at the time you
subject to verification, via paper, electronic media, or through the use of computer matching
complete this form.
programs, with national, state, local or other charitable or social security administrative
agencies to determine and issue benefits under their programs. In addition, to the extent this
We estimate this form takes an average of 15 minutes to complete, including the time for
information indicates possible violation of civil or criminal law, it may be shared and verified,
reviewing instructions, getting the needed data, and reviewing the completed form. Send
as noted above, with an appropriate Federal, state, or local law enforcement agency.
comments regarding our estimate or any other aspect of this form, including suggestions for
reducing completion time, to the Office of Personnel Management, Retirement Services
We also ask for the Insured's Social Security Number to use it as an individual identifier in the
Publications Team (3206-0136), Washington, D.C. 20415-3430. The OMB number,
Federal Employees' Group Life Insurance Program.
3206-0136, is currently valid. OPM may not collect this information, and you are not required
to respond, unless this number is displayed.
KEEP YOUR DESIGNATION CURRENT. SUBMIT A NEW ONE IF THE ADDRESS OF ONE OF YOUR BENEFICIARIES CHANGES OR IF YOUR
INTENTIONS CHANGE (FOR EXAMPLE, DUE TO A CHANGE IN FAMILY STATUS, SUCH AS MARRIAGE, DIVORCE, DEATH, BIRTH, ETC.).
SF 2823
Back of Part 2
Revised May 2014
