Signature
I elect to exclude the decedent's military service from my
survivor annuity.
Date
3. Social Security number
Part A - To be completed by employing agency
Part B - To be completed by survivor
Part C - To be completed by survivor of deceased employee in receipt of military retired pay
at the time of death
Our records indicate that you might be eligible for a civil service annuity. You have the right to make a deposit for the
deceased employee's post-1956 military service. Your decision may affect your rights under CSRS. Read the attached
"Information for the Survivor of a Deceased CSRS Employee..." carefully to be sure you understand the consequences of not
making the deposit for military service. Then make your election, sign and date the form, and return two (2) copies to the
address shown in item 8 above. If you have decided to pay the deposit, we will provide you with the necessary information.
Payment must be made in a lump sum to this agency before the Office of Personnel Management completes its adjudication
of your application for survivor benefits.
Survivor Election - I have read the information concerning my right to make a lump sum deposit to the decedent's employing
agency for post-1956 military service.
I elect to make (or complete) the deposit to the employing
agency for the decedent's post-1956 military service. I
understand that this deposit must be paid to the agency in
a lump sum. (Note: The election may be changed at any
time before the deposit is actually paid to the agency.)
I elect not to make (or complete) the deposit for post-
1956 military service. I understand this decision is
irrevocable.
If the deceased employee received military retired or retainer pay that was (1) not awarded because of a service-connected
disability incurred either in combat with an enemy of the United States or caused by an instrumentality of war and incurred in
the line of duty during a period of war, or (2) awarded under reserve retiree provisions (chapter 67 of title 10, United States
Code), you will receive credit for the military service subject to the rules for post-1956 military deposits. However, if you do
receive credit for military service (including any pre-1957 military service), your CSRS survivor benefit must be reduced by
the amount of any military survivor benefits payable to you. In some instances, it may be advantageous to receive a survivor
benefit including the military service in the computation. In order to advise you about the survivor annuity benefits, we need
to know if you are eligible for military survivor benefits. Your documentation or verification of your entitlement to military
survivor benefits should be attached as indicated.
Survivor Election - To exclude military service from the computation of your survivor annuity, etc., check the appropriate
box below.
I have attached verification of my eligibility or ineligibility for military survivor benefits.
(Specify monthly amount, if known $ .)
Other (Specify here or on a separate sheet of paper).
4. Is survivor eligible for an annuity based on the minimum basic
annuity?
Yes (Complete item 4a) No, annuity will be based
on actual service
4a. If item 4 is "yes" would loss of credit for post-
1956 military service reduce the amount of the
annuity?
Yes No
5. Was a deposit account opened for the employee? Yes, complete information below No
Period of Military Service
6. Agency records show the above named deceased employee was first employed under the Civil Service Retirement
System (CSRS) and had post-1956 military service for which a deposit has not been made or has not been completed.
before October 1, 1982 on or after October 1, 1982
1. Employee's name 2. Date of birth
From To
Amount due (with
interest)
Amount paid by
employee
Balance due
7. Agency representative to contact for information
Telephone number
8. Agency personnel office address to which form should be returned
Election must be received by (date)
OPM Form 1519
Rev. January 1991
Office of Personnel Management
Deceased Employee Covered by CSRS or CSRS Offset
SURVIVOR'S MILITARY SERVICE ELECTION