Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System

OMB 3206-0162

OMB 3206-0162

OPM Form 1530 is designed to collect information from both the applicant and the applicant’s physician regarding the applicant’s health. This information is used to determine whether the insurable interest survivor benefits election can be allowed. The form has been revised to bring it up-to-date. Specifically, solicitation of this information is also authorized by the Federal Employees Retirement System (Chapter 84, title 5, United States Code).

The latest form for Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System expires 2021-01-31 and can be found here.


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