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; itexpires on.
Date ofbirth
(Month, day, year)
Privacy Act Information
Name
(Last, first, middle)
Date ofbirth
(Month, day, year)
Social Security Number
A.
Section 1. Employee Identifying Information
(Type or print)
Section 2. Addresses for OPM's Response
Employing office addressEmployee'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 ithas a court order on file that awards benefits to my former
spouse identified in Section 3.
B.
Ifa court order is on file atOPM, I request that OPM grant me a 6-month extension oftime in which Ican elect
FERS coverage. I understand that the six-month period will run from the date myrequest is approved.
C.
Ifa court order is on file atOPM, I request that OPM waive the requirement that myformer spouse consent tomy
election ofFERS 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 aqualifying court order awarding CSRS benefits to the employee's former spouse. The employee may
not elect FERS coverage unless (1) the former spouseconsents to the election, or (2) the court order is modified to
remove the award ofretirement or death benefits to the former spouse.
See attached correspondence regarding your request for a waiver of the former spouse consent requirement.
Signature ofOPM official
Date
Solicitation of this information is authorized bythe Federal Employees Retirement Act
(Public Law 99-335). The information you furnish will beused 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 issubject 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 toreport income for
tax purposes. Itmay 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, isvoluntary, but failure todoso may delay or make itimpossible for us to
determine your eligibility to elect FERS coverage.
(Formerly OPM Form 1560)Standard Form
3111
(6-90)
Office ofPersonnel Management
5CFR 846
(date)
After OPM returns form with Section 5 completed.
Attach one copy ofthis request form toPart 2 of the Standard Form 3109
(Election of Coverage). In the space inSection 5ofthe Standard Form 3109,
note "Standard Form 3111 received" and the date received on both Parts 2
and 3. File them onthe right side of the OPF. (Note: Please make sure that
Parts 2 and 3 of the employee’s Standard Form 3109 are correctly dated.)
Donot 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 anexcluded appointment to one that isnot
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 aformer spouse. These conditions are:
aqualifying court order awards a portion of your CSRS annuity or CSRS
survivor benefit to a former spouse; AND
the court order isonfile at OPM; AND
the former spouse isstill alive; AND
the former spouse has not remarried before age 55.
If you think you are one ofthe few employees whose former spouse obtained a
qualifying court order that may be on file with OPM, you can ask OPM ifit has
acourt order onfile. You can also ask OPM togive 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 isnot required (that is, byeliminating any right of your former spouse
to your future retirement benefit and/or a survivor benefit). In addition, you can
ask OPM towaive the requirement that your former spouse consent to your
FERS election.
You may use this form torequest t h at OPM: check tosee ifa qualifying court
order ison 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 isa 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 acopy 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 arequest for waiver. If
you do not supply the required documentation, OPM cannot grant
your request for a waiver.
Sign and date inSection 4.
Submit four (4) copies of this form with Parts 2 and 3ofyour 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 ofFERS coverage, you must submit the following
documentation:
1.Ajudicial or administrative determination that your former spouse's
whereabouts cannot be determined.
2.Affidavits byyou and two other persons, at least one ofwhom isnot
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 asnewspaper reports about the former spouse's
disappearance.
3.
Ajudicial 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 ofits 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 ofthe first pay
period after OPM notifies you thatithas granted the employee’s request
for awaiver or that there isNOcourt order on file with OPM. If the
employee presents aproperly completed Former Spouse Consent Form
within the deadline (or extended deadline asgranted 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 benecessary for OPM toreview
modifications of court orders to determine whether the restrictions against
the employee's retirement account have been removed. Inthese cases,
the election ofFERS is effective at the beginning of the first pay period
after the employing office receives OPM's notification thatthe former
spouse's consent isno longer required.
.
Standard Form 3111 (back )
