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

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Agency Information & Certification • SF 3104B, Section 4 – Information and Elections Regarding Post-1956 Military Service • SF 3104B, Section 5 – rollover Option Information for Lump Sum Benefits Payable to Surviving Spouse or Surviving former Spouse • Required in all cases with military service after 12/31/56 for which employee did not complete deposit and a survivor annuity is payable. • Required in all cases with Basic Employee Death Benefit or if employee contributions, excess retirement deductions or voluntary contributions are payable to the surviving spouse/former spouse. If not completed, payment may be 44
Agency Information & Certification • Death Certificate • Certified copy required in all cases • Marriage Certificate • Children’s Birth Certificate • Medical Documentation (disabled d children) • Adoption papers • Required for all married employees • Required for all minor or student children • Required for all disabled children • Required if applicant is an adopted child 45
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 and 42: Agency Information & Certification
Page 43: 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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