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fe6, Claim for Death Benefits

In the case of wanting to claim death benefits, the following form has to be completed and submitted.


Extracted Text for Proper Search

Claim for Death Benefits 	
Federal Employees’ Group Life Insurance (FEGLI) Program 
(To file an Option C-Family Benefits claim, use form FE-6 DEP) 	
Who receives the FEGLI life insurance benefits? 	
The law states that FEGLI benefits will be paid in the following manner:\
If the deceased did not assign ownership and there is no valid court ord\
er on file with the employing agency or the Office of  
Personnel Management (OPM) (if retired), then the Office of Federal \
Employees' Group Life Insurance (OFEGLI) (an  
administrative office of MetLife) will pay: 
• 	First, to the beneficiary(ies) the insured validly designated 	
• 	Second, if none, to the insured's widow or widower 	
• 	Third, if none of the above, to the insured's child or children and desc\
endants of any deceased children (a court will usually  
appoint a guardian to receive payment for a minor child) 	
• 	Fourth, if none of the above, to the insured's parents in equal shares, \
or the entire amount to the surviving parent 	
• 	Fifth, if none of the above, to the court-appointed executor or administ\
rator of the insured's estate 	
• 	Sixth, if none of the above, to the insured's other next of kin, entitle\
d under the laws of the state where the insured lived 
If the insured did not assign ownership and there is a valid court order\
 on file with the agency or the U.S. Office  
of Personnel Management (OPM), as appropriate, OFEGLI will pay benefit\
s according to the court order. 
If the insured assigned ownership of his/her life insurance to someone e\
lse (generally by filing an RI 76-10, Assignment form),  
then OFEGLI will pay: 	
• 	First, to the beneficiary(ies) the assignee(s) validly designated 	
• 	Second, if none, to the assignee(s) 	
Completing this form 	
Please complete this  Claim for Death Benefits  form by following the instructions on the form. Only use this form for t\
he death of 
a Federal employee, annuitant, or compensationer. If you are filing a cl\
aim for a dependent, use form FE-6 DEP. Each claimant/  
beneficiary is required to complete their own form. Provide all of the i\
nformation requested, so OFEGLI may process your claim  
as quickly as possible. If you have questions, or need help completing t\
his form, call OFEGLI at  1-800-633-4542. Our Customer  
Service Center is open Monday through Friday, 8:30 a.m. to 4:00 p.m. EST\
If you have not previously notified the employing agency or OPM (if ret\
ired) of the death, please contact the appropriate office.  
The easiest way to report the death of a Federal retiree is online at:	
or you can report the death by calling  OPM at 1-888-767-6738 . 	
You have the following options to receive your life insurance proceeds: \
• 	A Total Control Account	®
 in your name (you may select this option if your benefits are $5,000 or\
 greater), or 	
• 	A check that we mail to you 
Please read About the Total Control Account (Page 2) for details. Indi\
cate your choice on Page 5 when completing the claim  
form. If you do not choose an option and your benefits are $5,000 or gre\
ater, a MetLife Total Control Account will be established  
in your name and your payment will be deposited on your behalf. 	
A. 	Check off the items you’re sending with this claim form 	
Death Certificate. We require a certified copy of the death certificate with the cause and \
manner of death. The funeral   
director taking care of the funeral arrangements or your state bureau of\
 vital statistics can usually provide a copy of the   
death certificate. We only require one death certificate -  if you're aware of another claimant who's sending one, you don't   
have to send it. 
If you signed a document with a funeral home that authorizes us to make \
a payment directly to them, a copy of that  
If the insured was an active employee and died in an accident, and you’\
re making an accidental death benefit claim, proof of  
the accident - police reports and other supporting documents. 
If you are filing this claim on behalf of the estate, a copy of the appo\
intment papers issued by the court. 
If a trust is designated, a statement that the trust is still in effect \
and you are authorized to act under the trust, and a copy of  
the trust document. If you are not the original trustee, a copy of the p\
age naming you as successor trustee. 
If you have a Power of Attorney, a copy of the appointment papers naming\
 you as the attorney-in-fact for the beneficiary. 	
B. 	Submission instructions 	
Return this claim form and the necessary documents to: 
PO Box 6080 
Scranton, PA 18505-6080  Overnight Address: OFEGLI 
10 E.D. Preate Drive 
Moosic, PA 18507 	
If a certified death certificate has  
already been submitted, you may  
fax your claim form to OFEGLI at:  
Do NOT use previous editions	Page 1	Form FE-6 
Revised December 2016

Claim for Death Benefits 	Federal Employees’ Group Life Insurance Program 	
Part G: Select a method to receive your payment 	
Please SELECT ONE method of settlement in order to receive your payment. By selecting bel\
ow, you confirm that 
you have read the enclosed materials on both FEGLI payment options. Total Control Account (TCA) 	
FEGLI death benefits are not subject to Federal income tax, but the inte\
rest that OFEGLI pays on those benefits is subject to  
such tax. OFEGLI will report all interest payments to the Internal Reven\
ue Service (IRS). 	
Part H - Information about you 	
Please note: If you are completing this claim on behalf of someone else \
(such as a minor), complete all of Part H with that  
person's information, and not yours. Sign your own name "on behalf of" t\
he other person. 
Name (please print) Relationship to the insuredDate of birth
Address (number, street, apartment number) 
City StateZIP
Social Security number  or Estate/Trust/Tax ID Number 
Daytime Telephone number Email address
Under penalties of perjury, I certify: 
1. That the number shown as my Social Security Number in "Part H: Informati\
on about you" is my correct taxpayer identification 	 	number, and2. That I am NOT subject to backup withholding because: (a) I have not be\
en notified by the Internal Revenue Service (IRS) that I am 	 	subject to backup withholding as a result of a failure to report all int\
erest and dividends, or (b) I am exempt from backup 	 	withholding, or (c) the IRS has notified me that I am no longer subjec\
t to backup withholding, and 3. I am a U.S. citizen, resident alien, or other U.S. person*, and 4. I am not subject to Foreign Account Tax Compliance Act (FATCA) reporti\
ng because I am a U.S. person* and the account is 	 	located within the United States. 
(Please note: You must cross out Item 2 above if the IRS has notified y\
ou that you are currently subject to backup withholding because you  
failed to report all interest or dividend income on your tax return.) 
*  If you are not a U.S. Citizen, a U.S. resident alien or other U.S. perso\
n for tax purposes, please cross out Item 3 above, and complete form  
W-8BEN (individuals) or W-8BEN-E (entities). The Internal Revenue Service does not require your consent to any provis\
ion of this document other than the certifications required to avoid  
backup withholding. 
Signature 	If you are completing this claim on behalf of someone else sign your own\
 name "on behalf of" the other person.  Today's Date 
Warning -  If you knowingly and willfully make any materially false, fictitious, or\
 fraudulent statement or representation on this form, or conceal a mater\
ial fact related 
to the requests for information on this form, you may be subject to a mo\
netary fine or imprisonment for not more than five years, or both under \
18 U.S.C. 100 	
Please return pages 3 through 5 to OFEGLI 	
Do NOT use previous editions	Page 5	Form F-6 
Revised December 2016
Next: Form I-134, Affidavit of Support Previous: Financial Affidavit in Support of Petition for Waiver of Fees
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