Fillable Printable Form RI 38-031
Fillable Printable Form RI 38-031
Form RI 38-031
United States
Form Approved:
Office of Personnel Management
OMB number 3206-0187
Check Loss
PO Box 7815
Washington, DC 20044-7815
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We Need Information About Your Missing Payment
You may report a missing annuity or survivor annuity payment on the internet at apps.opm.gov/retire/payment/missing_pay.cfm. Or,
you may use page 2 of this form to report that you have not received a payment authorized by the retirement system, because the
payment was lost, stolen, destroyed, or (if a direct deposit) it was not properly credited to your account at a financial organization. If
you wish to file a report of nonreceipt of payment, please complete page 2 of this form. Remember to sign it and return it without delay
to the address shown at the top of this page. The Office of Personnel Management (OPM) will send your report to the Department of the
Treasury, which maintains all records on issued payments, so that corrective action may be taken on your behalf.
The retirement system will send your report to the Department of the Treasury as quickly as possible after receipt of the completed form.
If your payment was a check, the Department of the Treasury will determine whether it has been cashed. If it has not been cashed, a
replacement check will be sent to you. If it has been cashed, the Department of the Treasury will contact you with further instructions.
If your payment was by direct deposit, you need to contact your financial organization before you complete this form. If your financial
organization cannot help you, complete Parts A, B, and C and sign the certification. The Treasury will trace the payment and contact you
with further instructions.
You must return this notice to us. We cannot take any action until you complete the form on page 2 of this notice and return the
information to us. If you need assistance in completing this form, telephone OPM's Retirement Information Office at 1-888-767-6738.
Our hours are 7:30 a.m. to 7:45 p.m. Eastern time.
Retirement Operations
Reports of lost or stolen checks outnumber reports about not receiving direct deposits by one hundred to one.
Get direct deposit -- know your payments are safe and sure.
Privacy Act Statement Public Burden Statement
Title 5, U.S. Code, Chapter 83, Civil Service Retirement and Chapter 84, Federal Employees Retirement System
We estimate this form usually takes 10 minutes per response to complete;
authorize solicitation of this information. The data you furnish will be used to submit a claim for your missing
on occasion it may take up to 30 minutes, including the time for reviewing
payment. This information may be shared and is subject to verification, via paper, electronic media, or through
instructions, getting the needed data, and reviewing the completed form.
the use of computer matching programs, with national, state, local, or other charitable or social security
Send comments regarding our estimate or any other aspect of this form,
administrative agencies to determine and issue benefits under their programs or to report income for tax purposes.
including suggestions for reducing completion time, to the Office of
It may also be shared and verified, as noted above, with law enforcement agencies when they are investigating a
Personnel Management, Retirement Services Publications Team
violation or potential violation of civil or criminal law. Executive Order 9397 (November 22, 1943) authorizes
(3206-0187), Washington, DC 20415-3430. The OMB number, 3206-0187
the use of the Social Security number as an individual identifier to distinguish between people with the same or
is currently valid. OPM may not collect this information, and you are not
similar names. Failure to furnish the requested information may result in OPM being unable to assist you.
required to respond, unless this number is displayed.
RI 38-31
Previous editions are usable.
Revised May 2011
A. Payee Information and Statement
The retirement payment described below has not been received
or has been lost.
Name of person to whom payment was sent
If the address to the left should be changed and you have not
notified the Office of Personnel Management, write your
correct address below.
Name
Street address, including apt. no. to which check was sent
Street address, including apt. no.
City State ZIP Code
City
State ZIP Code
The missing payment is
A direct deposit to a financial organization
Have your financial organization verify nonreceipt by completing Part C below.
Yes
Yes
No
No
B. Description of the Missing Payment - Answer question 1 below and follow the instructions beside the block you check.
Did you sign your name on the check before it was missing?
Did you receive the missing check?
A check
1. The missing payment is (check one block).
Annuity/alternative annuity Death benefit lump sum payment
(Answer questions 2, 3, and 4 below.) (Answer questions 2, 3, 4, 5, 6, and 7 below.)
Survivor annuity Refund of retirement deductions
(Answer questions 2, 3, 4, and 5 below.) (Answer questions 3, 4, 8, and 9 below.)
2. Claim number (CSA is an annuity claim; CSF is a survivor annuity or a death benefit lump sum payment claim. Enter your claim number in the blank that applies to
you.)
CSA CSF
3. Approximate date of payment (mm/dd/yyyy) 4. Amount of payment
$
5. Full name of the deceased former employee (last, first, middle)
6. Former employee's Social Security Number 7. Former employee's date of birth (mm/dd/yyyy)
8. Your Social Security Number 9. Your date of birth (mm/dd/yyyy)
C. Description of Direct Deposit - If your payment is being deposited directly to a financial organization, complete this part.
Financial organization routing Depositor account number Type of account (check one)
Financial organization name and address
Checking Savings
Please review the above responses to be sure you have provided all the information requested on the line you checked in item 1.
Warning: If, after you receive a replacement payment as a result of this claim, we determine that you cashed or received the benefit
of both the original and any replacement payments, we will take prompt action to recover the amount of the overpayment
from you.
Certification - I certify that the payment described was not received or was received and is missing.
Signature Telephone number Date (mm/dd/yyyy)
Page 2, RI 38-31
Revised May 2011
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