Request For Change To Unreduced Annuity
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Request For Change To Unreduced Annuity Form. This is a Official Federal Forms form and can be use in Retirement And Insurance US Office Of Personnel Management.
Tags: Request For Change To Unreduced Annuity, RI 20-120, Official Federal Forms US Office Of Personnel Management, Retirement And Insurance
OMB No.: 3206-0245
U.S. Office of Personnel Management
Retirement Services and Management Group
P.O. Box 45
Boyers, PA 16017-0045
Request for Change to Unreduced Annuity
In order to change my benefit to the unreduced annuity rate, I am providing the information
The reason my marriage ended is:
The date my marriage ended is:
I have enclosed: (Check one block below.)
A copy of the death certificate.
A court-certified copy of my divorce decree, including all property settlements.
A court-certified copy of my annulment.
I understand that if I have self and family health benefits coverage, I can change to self-only at
Change my coverage to self-only.
(Note: Check this block if you want to make the change. A former spouse is no longer a
family member and is not eligible for coverage under your family enrollment.)
Signature (do not print)
Name (last, first, middle initial)
Telephone number including area code
Public Burden Statement
We think this form takes an average of 30 minutes per response to complete. Send comments regarding our estimate or any other aspect of this
form, including suggestions for reducing completion time, to the Office of Personnel Management, OPM Forms Officer (3206-0245), Washington,
D.C. 20415-7900. The OMB number 3206-0245 is currently valid. OPM may not collect this information, and you are not required to respond,
unless this number is displayed.
Previous editions are not usable.
Revised September 2006
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