Nrcs Form Sf3102

We think providing this information takes an average of 15 minutes per response to complete including the time for reviewing instructions getting the needed data and reviewing the completed form. Send comments regarding our estimate or any other aspect of SF 3102 including suggestions for reducing completion time to the U.S. Office of Personnel Management OPM Reports and Forms Manager Paperwork Reduction Project 3206-0173 Washington D.C. 20415-7900. Designation of Beneficiary Form Approved OMB No* 3206-0173 Federal Employees Retirement System Retirement System Important Read all instructions before filling in this form A. Identification Name Last first middle Place an X in the appropriate box Date of birth Month day year An employee Retired or an applicant for retirement Social Security Number Former employee eligible for retirement in the future If you are retired give your claim number Department or agency in which presently employed or former department or agency Bureau Division I the individual identified above designate the beneficiary or beneficiaries named below to receive any lump-sum benefit which may become payable under the Federal Employees Retirement System FERS after my death. I understand that this designation of beneficiary is also for any lump-sum benefit which may become payable under the Civil Service writing or I receive payment of my employee deductions for FERS and CSRS if applicable. Location City state and ZIP code I direct unless otherwise indicated below that if more than one or who may be disqualified for any other reason shall be distributed equally among the stated beneficiaries or entirely to the survivor. If none of the beneficiaries are alive and eligible to receive payment when a lump-sum payment becomes payable this designation is void and payment will be made according to the order of precedence set by law. B. Information Concerning The Beneficiaries See Examples of Designations Address Including ZIP code of each beneficiary First name middle initial and last name of each beneficiary Date of designation Month day year Relationship Your signature Share to be paid to Total 100 C. Witnesses A witness is not eligible to receive payment as a beneficiary We the undersigned certify that this statement was signed in our presence. Signature of witness Number and street City state and ZIP code Receiving agency certification I have reviewed this designation and certify that the designated shares total 100 and that no witnesses are designated as beneficiaries. Date received Signature Date Type or print your return address to insure return of See Back of Employee Copy For Instructions On Where To File This Form* Retain until employee leaves Federal service and then send to OPM U*S* Office of Personnel Management 5 CFR 843 Part 1 - Original NSN 7540-01-246-9252 3102-103 Previous editions are usable Standard Form 3102 Revised June 2000 Important - The filing of this form will completely cancel any Designation of Beneficiary under the Federal Employees Retirement System or under the Civil Service Retirement System you may have previously filed* Be sure to name in this form all persons you wish to designate as beneficiaries of any lump sum payable at your death.