12th Annual Federal Workers' Compensation Conference S i #39 ...

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Agency Information & Certification • SF 3104 – • Unless not covered Application for Death under an FEHB plan) Benefits (Required) • SF 2809s – Employee Health Benefit Election Forms (Required) • DD 214 – Military Discharge (Recommended in all cases with military service) • SF 2810s – Notice of Change in Health Benefits Election Form (Required, • SF3104B, Section 1 – Certified Summary of <strong>Federal</strong> Service (Required) 42
Agency Information & Certification • SF 3104B, Section • Required in all 2 – Basic Employee Death Benefit cases where a Basic Employee (BEDB) Death Benefit is payable • SF 3104B, Section 3 – Health Benefits Election • Required in all cases where a Basic Employee Death Benefit is payable and a survivor annuity is 43
Page 1 and 2: 12 th Annual Federal Workers’ Com
Page 3 and 4: Death Benefits under § 8133 • FE
Page 5 and 6: Agency Responsibilities • The sup
Page 7 and 8: Timely claim • Survivors must giv
Page 9 and 10: Who is eligible under § 8133? •
Page 11 and 12: NOTE If a widow or widower receivin
Page 13 and 14: How does OWCP calculate the FECA/FE
Page 15 and 16: How are these benefits claimed? •
Page 17 and 18: FECA Death Gratuity • New § 8102
Page 19 and 20: Contingency Operations • The stat
Page 21 and 22: Order of Precedence • Section 810
Page 23 and 24: Offset of other gratuities • The
Page 25 and 26: References • 5 U.S.C. § § 8101,
Page 27 and 28: PLANNING YOUR NEEDS • Who has Pas
Page 29 and 30: CONTACTING THE FAMILY • 5Copeso C
Page 31 and 32: Required Documents • Social Secur
Page 33 and 34: DOCUMENTS REQUIRED • DD 214’S S
Page 35 and 36: Standard Form 3104B • Certified e
Page 37 and 38: Survivor’s Military Service Elect
Page 39 and 40: Agency Information & Certification
Page 41: Agency Information & Certification
Page 45 and 46: Agency Information & Certification
Page 47 and 48: Claim for Death Benefits (FEGLI) FE
Page 49 and 50: Claim for Death Benefits (FEGLI)
Page 51 and 52: Death Benefits Payout (FEGLI) • I
Page 53 and 54: REPORT OF PUBLIC SAFETY OFFICER’S
Page 55 and 56: Form TSP-17 - Information Relating
Page 57 and 58: Veteran’s Administration • Info
Page 59 and 60: Claim for Compensation by Widow,
Page 61 and 62: Death Gratuity Payment Authority
Page 63: QUESTIONS? Contact Information Greg

12th Annual Federal Workers' Compensation Conference S i #39 ...

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