Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits

OMB 3206-0233

OMB 3206-0233

RI 25-51 will be used by the Civil Service Retirement System solely to pay benefits to the widow(er) of an annuitant. This application is intended for use in immediately authorizing payments to an annuitant's widow or widower, based on the report of death, when our records show the decedent elected to provide benefits for the applicant. The Privacy Act Statement has been revised due to a systematic review by our Chief Privacy Officer.

The latest form for Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits expires 2023-11-30 and can be found here.


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