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Fillable Printable SF 3110

Fillable Printable SF 3110

SF 3110

SF 3110

When properly completed, this form is considered a part of
the employee's election and must be attached to the election
Former Spouse's Consent to FERS Election
Federal Employees Retirement System
Employee Instructions
I certify that the person named in Part 2 presented identification (or was known to me), gave consent, signed or marked this form, and
acknowledged that the consent was freely given in my presence on the day of , 19 at
.
Signature
Read "Information for Employee" on the back of this form. If a
qualifying court order, on file with the Office of Personnel
Management, awards a portion of your annuity or a survivor
annuity based on your Federal service to a former spouse
who has not remarried before reaching age 55, you cannot
elect coverage under the Federal Employees Retirement
System (FERS) unless your former spouse consents to your
election. Complete Part 1 of the form. Have your former
spouse complete Part 2. Part 2 must be completed in the
presence of a Notary Public or other person authorized to
administer oaths. The Notary Public must complete Part 3.
Part 1 -- To Be Completed by Employee
(type or print)
Name
(Last, first, middle)
Date of birth Social Security Number
Part 2 -- To Be Completed by Former Spouse of Employee
(Before completing, read "Information for Former Spouse" on the back of this form.)
I freely consent to the election of coverage under the Federal Employees Retirement System made bythe employee named in
Part 1, who is my former spouse. I understand that my consent is final (not revocable).
Name
(type or print)
Signature
(Do not print)
Date
Part 3 -- To Be Completed by a Notary Public or Other Person Authorized to Administer Oaths
(city and state)
(month)(year)
Expiration date of commission if Notary Public
Privacy Act Statement
Solicitation of this information is authorized by the Federal
Employees Retirement Act (Public Law 99-335). The information
you furnish will be used to determine whether the employee’s
election of coverage may become effective. 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 in order to determine benefits under their programs, to
obtain information necessary for determination or continuation of
benefits under this program, 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 the civil or criminal law. Executive Order 9397
(November 22, 1943) authorizes use of the Social Security Number.
Furnishing the Social Security Number, as well as other data, is
voluntary, but failure to do so may mean that your election of FERS
coverage cannot become effective.
Employing Office Instructions
form, Standard Form 3109, and filed with it as a permanent
document on the right side of the employee's OPF.
(seal)
(Formerly OPM 1556)
Standard Form 3110 (6-90)
Office of Personnel and Management
5 CFR 846
Information for Employee
If you are unable to obtain the consent of your former spouse,
you may request OPM to:
You do not need your former spouse’s consent to your election
if:
Information for Former Spouse
Your former spouse has an opportunity to transfer to the
Federal Employees Retirement System (FERS) or stay in the
Civil Service Retirement System (CSRS). If the terms of your
divorce give you a portion of your former spouse’s annuity or a
survivor annuity, and a copy of this court order is on file with
OPM, he or she cannot elect FERS without your consent.
FERS is a three-part program composed of the Basic Benefit
Plan, Social Security, and the Thrift Savings Plan. Employ-
ees who stay in CSRS may also participate in the Thrift Plan.
OPM administers only the Basic Benefit Plan of FERS. The
same requirements that OPM honor court orders apply to both
CSRS benefits and FERS basic benefits.
Future benefits to which you are entitled may be affected if the
Federal employee changes from CSRS to FERS. An annuity
under the FERS basic benefit plan is generally smaller than
an annuity under CSRS; therefore, if the court order awards
you a percentage of the employee’s annuity, the amount you
receive may be smaller if the employee changes to FERS
coverage.
Under CSRS, former spouses may be entitled to a survivor
annuity of up to 55% of the employee’s retirement benefit
(depending on the terms of the court order). Under FERS, a
survivor annuity for a former spouse cannot normally exceed
50% of the amount of the employee’s annuity.
grant a waiver of the consent requirement if you
cannot determine where the former spouse is
located, or
give you additional time so that you can get a
modification of the court order.
If you are not sure whether a qualifying court order is on file at
OPM, you may request that OPM make a determination as to
whether a court order is on file. Ask your employing office for
Standard Form 3111, which has the information about how to
make any of these requests of OPM.
There is no qualifying court order on file at the Office
of Personnel Management that gives a portion of your
annuity or survivor annuity to your former spouse.
You are legally separated, but there is no final divorce
decree.
After your divorce your former spouse remarried
before reaching age 55. (It does not matter whether
the former spouse is still married.)
You are staying in CSRS.
Under FERS, no monthly spousal survivor annuity is payable on
the death of an employee unless the employee has 10 years of
creditable government service. However, a lump sum survivor
benefit may be payable after 18 months of service. The lump
sum payment is equal to $15,000, which is adjusted for inflation,
plus half the amount of the employee’s annual pay at the time of
death. In addition, an employee under FERS is also covered by
Social Security. Therefore, if your marriage to the employee
lasted for at least 10 years, you may become eligible for Social
Security benefits for divorced spouses.
NOTE:
You are not required to obtain a modification of
the court order now on file at OPM if the employee
changes to FERS. The terms of the court order will be
applied to Basic Benefits that become payable under
FERS, except that the amount of benefits paid cannot
exceed the amount payable under FERS. However, in
the case of benefits from the Thrift Savings Plan (TSP),
a court order must specify that it applies to the TSP and
it must be filed with the Thrift Savings Board at the
following address:
Federal Retirement Thrift Investment Board
Ben Franklin Station, P.O. Box 511
Washington, D.C. 20044
SF 3110 (back)
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