DA Form 3715: Disposition of Retirement Benefits

In Section I, General Information, box 1 is the Employee's Name (Last, first, MI), box 2 the Social Security Number and box 3 the Date of Birth (YYYYMMDD).

Box 4a is the Complete Mailing Address, box 4b the E-Mail Address, box 5a the Area Code/Telephone Number and box 5b the Fax Telephone Number.

Box 6 is the Service Computation Date (YYYYMMDD), box 7 the Date of Separation and Reason (YYYYMMDD), box 8 the Accumulated Sick Leave Hours, box 9 the Employing NAF and box 10 the Standard NAF Number.

Box 11 is the Marital Status: Not Married or Married.

Box 12 is the Name of Legal Spouse (Last, First, MI), box 13 the Social Security Number of Legal Spouse, box 14 the Date of Birth of Legal Spouse (YYYYMMDD) and box 15 the Date of Marriage (YYYYMMDD).

An official copy of the Death Certificate, Divorce Decree, Property Settlement Agreement and/or Qualified Domestic Relations Order (as applicable) is required to be submitted to the Employee Benefits Office with this document.

In Section II, Retirement Fund Options, box 16 is CHECK ONE: In accordance with AR 215-3.

a. I request a refund of my contributions and accumulated interest in full satisfaction of all annuity payable.

I understand that electing a refund of my contributions plus interest voids my eligibility to receive any future monthly retirement benefit and accepting this refund is the final payment. If married, waiver from the spouse consenting to the refund of contributions instead of the lifetime benefit is required.

Employee contributions plus interest computed in accordance with the plan document will be paid to employees who request a refund.

Participating employees with 5 years or more credited service are vested.

When a vested employee requests a refund of his or her contributions, a waiver from his or her spouse (if married) consenting to the refund of contributions instead of the lifetime benefit will be included with the refund request.

b. I request my contributions remain in deposit for a maximum of 5 years.

Employee with less than five years of creditable service may request that their contributions remain on deposit.

Upon reemployment/reinstatement their service will be fully creditable for retirement plan.

c. I request an immediate Annuity (Normal or Early Retirement)

Normal retirement.

Employees who have participated in the plan 5 years or more and are age 62 or older at the time of retirement will receive an unreduced benefit upon retirement.

Early retirement.

Employees who have participated in the retirement plan for 5 years and are age 52, or who have participated in the plan 20 years and are age 50, are eligible for a reduced retirement benefit payable immediately.

Employees who are age 55 with 30 years of credited service, or age 60 with 20 years credited service, may retire at any time with an unreduced benefit.

d. I request a Deferred Annuity payable at age 62.

Employees who work past age 62 and continue contributing to the plan continue earning benefits under the plan.

Their retirement benefit is paid when they retire or their employment is otherwise terminated.

e. I request Disability Retirement.

An employee who participated in the retirement plan prior to 2009 is eligible to apply for disability benefits if they have reached age 52 with 12 months or more of credited service immediately preceding retirement or have 5 years of credited service.

If hired after 2009, the employee must have 5 years of credited service.

f. I request Disability Retirement due to work related injury.

If employee is receiving workers' compensation benefits, their disability benefit when combined with their workers' compensation benefit, cannot exceed 90% of their HI-3 salary used in calculation of their monthly benefits.

g. I request Survivor Benefits.

A survivor benefit is payable to the spouse of a participant who has 5 years of credited service under the plan and who dies while actively employed.

The spouse must have been married to the employee for at least 1 year immediately preceding the employee's death.

Box 17 is the Signature of Employee/Survivor and box 18 the Date (YYYYMMDD).

Box 19: the information has been verified from the employee's personnel records and DA Form 3473 coded 04 is attached.

In Section IV, Verification and CPU Mailing Address and Signature, a is the CPU Signature, b the Date (YYYYMMDD), c the Mailing Address and d the E-Mail Address.