Fillable Printable Form RI 25-15
Fillable Printable Form RI 25-15
Form RI 25-15
Form Approved:
OMB No. 3206-0042
Notice of Change in
Student's Status
Show any address change next to your address below.
U.S. Office of Personnel Management
Retirement Surveys & Students Branch
1900 E Street, NW
Washington, DC 20415-3563
Claim number
For Agency Use Only
I
II III IV
Date Student's name
You have been receiving student survivor benefits for the student shown above based on self-certification of full-time
attendance that you provided to the Office of Personnel Management (OPM) covering all or part of the current school
year. This form is being sent to assist you in notifying OPM about events that affect eligibility to receive student
benefits. Only return this form if the student's status has changed. This precoded form can only be used for the
student shown above. If the student's status has changed, please return this form in the enclosed envelope or fax it to
(202) 606-0022. If you have any questions about this form, you can call our office at (202) 606-0249. Individuals
residing outside the Washington DC area can call our Retirement Information Office toll free at 1-888-767-6738. You
can also write to OPM at the address shown above.
1. Events
Reduced attendance to less than full-time
If any of the events shown in number 1 apply, fill in the appropriate oval. Please write the month, day, and year that the event
occurred or will occur inside the boxes provided in number 2. You should enter a leading zero for months and days with a
single number, for example, March 3, 2013, would be 03/03/2013.
Stopped school attendance (other than for regularly scheduled school breaks)
Married
Deceased
Entered military service on active duty
Entered a U.S. military academy
Transferred to a non-recognized school
2. Date of Event:
/ /
Warning: Any intentionally false or misleading statement, certification, or response you provide is a violation of the law punishable
by a fine of not more than $10,000, or imprisonment of not more than 5 years, or both (18 U.S.C. 1001).
I certify that all of the information given on this form is true and correct to the best of my knowledge and belief.
Payee's signature Daytime telephone number
Email address
Student's signature Date (mm/dd/yyyy)
RI 25-15
Previous editions are usable Revised July 2013
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Reverse of RI 25-15
Revised July 2013
Information For Completing The Notice of Change In Student's Status
Survivor benefits can be paid to children of deceased Federal employees and retirees. The children must be between
the ages of 18 and 22, unmarried, and full-time students in a recognized school. Full-time students must have a
sufficient subject load to allow them to graduate within the minimum time that is considered normal for a full-time
day student of the school. Generally, at a college or university, you must be enrolled for a minimum of 12 credit hours
per semester to be considered a full-time student. If you carry fewer than 12 credit hours at any time during the school
year but believe that school attendance was full-time, please send us a letter from the school stating whether the
school considers it full-time.
A recognized school is a non-correspondence institution of learning, high school, or above, that has a faculty and
requires that study or training be accomplished on its premises. Included are high schools that are licensed by the
state, and trade schools, colleges, and universities that are accredited by nationally recognized accrediting agencies.
Not included as "recognized" for purposes of receiving student benefits are: elementary schools, correspondence
schools, U.S. Military Academies, such as the U.S. Naval Academy, or any training program where a trainee receives
pay primarily as an employee (e.g., an apprenticeship training program).
1. reduces school attendance to less than full-time,
2. stops school attendance,
3. marries,
4. dies,
5. enters military service on active duty,
6. enters any of the U.S. military academies, or
7. transfers to a non-recognized school.
Benefits (payments) must stop if the student:
Eligibility Information
Students who attain age 22 during the school year (between September 1 and June 30) may receive benefits through
the end of the month preceding the month in which full-time schooling stops or June 30, whichever occurs first.
Solicitation of this information is authorized by the Civil Service Retirement System (Chapter 83, title 5 U.S. Code), and the Federal Employees
Retirement System (Chapter 84, title 5, U.S. Code). The information requested on this form is needed to support an annuity benefit or claim.
The information may be shared and is subject to verification via paper, electronic media, or through the use of computer matching programs,
with national, state, local, or other charitable or social security administrative agencies. This may occur in order to determine benefits under
their programs, to obtain information necessary for determination or continuation of benefits from OPM, or to report income for tax purposes. It
may also be shared and verified, as noted above, with law enforcement agencies when they are investigating a violation or potential violation of
civil or criminal law. Provision of this information is voluntary; however, failure to furnish the requested information may result in an
overpayment of annuity. We will have to collect any overpayment of annuity.
Notify OPM immediately if any of these events occurs. If you are paid benefits after any of these events, you have
been overpaid and we will have to recover the money from you.
We estimate that providing this information takes an average 20 minutes per response, including the time for reviewing instructions, getting the
needed data, and reviewing the requested information. Send comments regarding our estimate or any other aspect of this form, including
suggestions for reducing completion time, to the U.S. Office of Personnel Management, Retirement Services Publications Team (3206-0042),
Washington, DC 20415-3430. The OMB Number, 3206-0042, is currently valid. OPM may not collect this information, and you are not
required to respond, unless the number is displayed.
Privacy Act Statement
Public Burden Statement
