Fillable Printable SF 3111
Fillable Printable SF 3111
SF 3111
Before completing this form, read the attached Instructions for Employees and Information for Employees.
Request for Waiver, Extension, or Search
In Connection with Election of FERS Coverage
Notice to Agency: When OPM returns this form, see "Instructions for Employing Office" on the back of this form.
Signature of employee
Date
Your request for a six-month extension is approved; it expires on .
Date of birth
(Month, day, year)
Privacy Act Information
Name
(Last, first, middle)
Date of birth
(Month, day, year)
Social Security Number
A.
Section 1. Employee Identifying Information
(Type or print)
Section 2. Addresses for OPM's Response
Employing office address Employee's mailing address
Section 3. Spousal Identifying Information
Former spouse's name
(Last, first, middle)
Section 4. Request to OPM
I request that OPM determine whether it has a court order on file that awards benefits to my former
spouse identified in Section 3.
B.
If a court order is on file at OPM, I request that OPM grant me a 6-month extension of time in which I can elect
FERS coverage. I understand that the six-month period will run from the date my request is approved.
C.
If a court order is on file at OPM, I request that OPM waive the requirement that my former spouse consent to my
election of FERS coverage based on the attached documentation.
Section 5. OPM's Response
(To be completed by OPM)
OPM does not have on file a qualifying court order awarding CSRS benefits to the employee's former spouse. Proceed
with processing the employee's FERS election.
OPM has on file a qualifying court order awarding CSRS benefits to the employee's former spouse. The employee may
not elect FERS coverage unless (1) the former spouse consents to the election, or (2) the court order is modified to
remove the award of retirement or death benefits to the former spouse.
See attached correspondence regarding your request for a waiver of the former spouse consent requirement.
Signature of OPM official
Date
Solicitation of this information is authorized by the Federal Employees Retirement Act
(Public Law 99-335). The information you furnish will be used to identify records
properly associated with your election, to obtain additional information if necessary, to
determine and allow present or future benefits, and to maintain a unique and
identifiable claim file. 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 delay or make it impossible for us to
determine your eligibility to elect FERS coverage.
(Formerly OPM Form 1560) Standard Form
3111
(6-90)
Office of Personnel Management
5CFR 846
(date)
After OPM returns form with Section 5 completed.
Attach one copy of this request form to Part 2 of the Standard Form 3109
(Election of Coverage). In the space in Section 5 of the Standard Form 3109,
note "Standard Form 3111 received" and the date received on both Parts 2
and 3. File them on the right side of the OPF. (Note: Please make sure that
Parts 2 and 3 of the employee’s Standard Form 3109 are correctly dated.)
Do not make the employee’s FERS election effective until OPM
responds to the request or, if earlier, the employee furnishes the
former spouse’s consent before the deadline.
Instructions for Employing Office
.
Information for Employees
FERS is the retirement system for Federal Employees established by the Federal
Employees Retirement System (FERS) Act of 1986. Employees who are covered
by the Civil Service Retirement System (CSRS) may elect to transfer to FERS. If
you were hired (or converted from an excluded appointment to one that is not
excluded) on or after July 1, 1987, you may elect FERS coverage within 6 months
after you were hired (or converted).
You do not need the former spouse’s consent if you elect to remain in
CSRS.
Your current spouse doesn’t have to consent to your transfer from CSRS to
FERS. However, under certain conditions, you cannot transfer to FERS without the
consent of a former spouse. These conditions are:
a qualifying court order awards a portion of your CSRS annuity or CSRS
survivor benefit to a former spouse; AND
the court order is on file at OPM; AND
the former spouse is still alive; AND
the former spouse has not remarried before age 55.
If you think you are one of the few employees whose former spouse obtained a
qualifying court order that may be on file with OPM, you can ask OPM if it has
a court order on file. You can also ask OPM to give you a 6-month extension
of the time limit for making the election so that you can get the court order
modified so that your former spouse will consent to your election or so that
consent is not required (that is, by eliminating any right of your former spouse
to your future retirement benefit and/or a survivor benefit). In addition, you can
ask OPM to waive the requirement that your former spouse consent to your
FERS election.
You may use this form to request t h at OPM: check to see if a qualifying court
order is on file; give you an extension; or waive the consent requirement.
Use Standard Form 3110, "Former Spouse's Consent to FERS
Election", if your former spouse consents to your FERS election.
.
.
.
Complete this form if you want OPM to:
Instructions for Employees
-
-
-
determine whether there is a court order on file at OPM;
extend the deadline for your FERS election so you can obtain a
modification of the court order; or
waive the requirement that your former spouse consent to your election
of FERS.
OPM will return a copy of its response to the addresses you give in Section
2. Be sure to ask your employing office how their copy should be addressed
in order to reach the appropriate office quickly.
Be sure you attach all required evidence to support a request for waiver. If
you do not supply the required documentation, OPM cannot grant
your request for a waiver.
Sign and date in Section 4.
Submit four (4) copies of this form with Parts 2 and 3 of your FERS election,
according to your employing office's instructions.
.
.
.
.
.
Documentation required to support a request for waiver of the consent
requirement.
If you request that OPM waive the requirement that your former spouse
consent to your election of FERS coverage, you must submit the following
documentation:
1. A judicial or administrative determination that your former spouse's
whereabouts cannot be determined.
2.Affidavits by you and two other persons, at least one of whom is not
related to you, attesting to the inability to locate the former spouse and
stating the efforts made to locate the spouse, AND documentary
corroboration such as newspaper reports about the former spouse's
disappearance.
3.
A judicial determination regarding the former spouse that warrants waiver
of the consent requirement based on exceptional circumstances.
OR
OR
.
Initial Processing.
Send 3 copies of this request form (and any attached documentation) to:
Office of Personnel Management
Employee Service and Records Center
P.O. Box 200, Attn: FERS Election
Boyers, PA 16020
.
OPM will complete Section 5 and return one copy of its response to the
employee and one to the employing office. File the employing office copy
with the Standard Form 3109 in the employee's OPF.
.
Make the employee’s election effective at the beginning of the first pay
period after OPM notifies you that it has granted the employee’s request
for a waiver or that there is NO court order on file with OPM. If the
employee presents a properly completed Former Spouse Consent Form
within the deadline (or extended deadline as granted by OPM) the election
is effective at the beginning of the first pay period after you receive the
consent form. In some cases, it will be necessary for OPM to review
modifications of court orders to determine whether the restrictions against
the employee's retirement account have been removed. In these cases,
the election of FERS is effective at the beginning of the first pay period
after the employing office receives OPM's notification that the former
spouse's consent is no longer required.
.
Standard Form 3111 (back )
