Dd Form 2656-1 - Sbp Election Statement For Former Spouse Coverage - April 2009 Page 2
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1
2PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. Chapter 73, subchapter II; DoD Instruction 1332-42, Survivor Annuity Program Administration; DoD
Financial Management Regulation, Volume 7B; and E.O. 9397 (SSN).
PRINCIPAL PURPOSE(S): To establish a Survivor Benefit Plan election for the eligible former spouse of a servicemember.
ROUTINE USE(S): To former spouses for purposes of providing information, consistent with the requirements of 10 U.S.Code,
Section 1450(f)(3), regarding Survivor Benefit Plan coverage.
To spouses for purposes of providing information, consistent with the requirements of 10 U.S.Code, Section 1448(a), regarding
Survivor Benefit Plan coverage.
DISCLOSURE: Voluntary; however, failure to furnish requested information may result in delay in initiating Survivor Benefit Plan
coverage for a former spouse.
INSTRUCTIONS
GENERAL.
ITEMS 6 and 7. Self-explanatory.
Type or print all information in ink.
ITEM 8. Enter date of divorce decree, or amendment
requiring SBP.
RETIRED MEMBERS: Complete Sections I, II, and III. If
electing former spouse and child(ren) coverage, provide
information pertaining to eligible child(ren) in Item 10,
ITEM 9. Mark the appropriate block. If "Yes," provide the
"Dependent Children."
date that member's former spouse remarried. Former
spouse may remarry after age 55 and eligibility will not be
RETIRING MEMBERS: Complete Sections II and III, but
affected. If former spouse remarries before age 55,
make the election on DD Form 2656, "Data for Payment of
coverage is suspended and premiums are not deducted
Retired Personnel."
from member's retired pay for the duration of that marriage.
ALL MEMBERS AND FORMER SPOUSES must complete
If former spouse's marriage ends by death, divorce, or
Section III.
annulment, coverage will resume. Retiree or former spouse
must notify DFAS of any changes in former spouse's marital
When the form has been completed (ensure it is signed by
status, providing appropriate documentation.
both member and former spouse, and is properly
witnessed), submit it to:
ITEM 10. Retired members electing former spouse and
Defense Finance and Accounting Service
U.S. Military Retired Pay
child(ren) must list eligible children in this section. Only
8899 E. 56th Street
children resulting from the marriage of the member and the
Indianapolis, IN 46249-1200
former spouse are covered in a former spouse and
child(ren) election. The former spouse is the primary
Attach a certified copy of the divorce decree, amendment, or
other documentation as described in Items 3, 4, and 5. If
beneficiary; children receive an annuity only if the former
not received by DFAS within the first year following the date
spouse remarries before age 55 or dies. Indicate in block
of divorce, the election will be invalid.
10.e. if the child is incapable of self support and attach
substantiating documentation, if available. Eligible children
SECTION I.
of retiring members should be listed in Block 25 of DD Form
ITEM 1. Retired member places an X in the appropriate
2656.
block to indicate whether election is for former spouse, or
former spouse with child(ren) coverage.
ITEM 11. This block may be used for comments or
additional information not covered in the form.
SECTION II.
SECTION III.
ITEM 2. Indicate member's marital status by marking
appropriate block.
ITEMS 12 through 15. Self-explanatory.
ITEMS 3, 4, and 5. Mark the block that reflects legal basis
for coverage.
DD FORM 2656-1 (BACK), APR 2009
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