Dd 2656 1 Form – Fill Out and Use This PDF

In Item 1, Due to divorce, change my SBP coverage to (X one), the retired member places an X in the appropriate block to indicate whether election is for former spouse, or former spouse with child(ren) coverage.

If an election included child(ren), list in Item 10 only the child(ren) resulting from the marriage of the member and the former spouse. Include the date of birth and SSN for each child.

In Item 2, Are you currently married? (X one), indicate member's marital status by marking appropriate block.

In Items 3, 4, and 5, mark the block that reflects legal basis for coverage. Item 3: is this election being made pursuant to the requirements of a court order (X one). Item 4: is this election being made pursuant to a written agreement previously entered into voluntarily as part of or incident to a proceeding of divorce, dissolution or annulment (X one). Item 5, if YES to Item 4: was such voluntary written agreement incorporated in, ratified, or approved by a court order (X one).

Items 6 and 7, Date of birth of former spouse and Date married to former spouse (YYYYMMDD), are self-explanatory.

In Item 8, Date divorced from former spouse, enter date of divorce decree, or amendment requiring SBP (YYYYMMDD).

In Item 9, Has former spouse remarried?, mark the appropriate block. If YES, provide the date that member's former spouse remarried (YYYYMMDD).

Former spouse may remarry after age 55 and eligibility will not be affected.

If former spouse remarries before age 55, coverage is suspended and premiums are not deducted from member's retired pay for the duration of that marriage. If former spouse's marriage ends by death, divorce, or annulment, coverage will resume.

Retiree or former spouse must notify DFAS of any changes in former spouse's marital status, providing appropriate documentation.

Retired members electing former spouse and child(ren) must list eligible children in Item 10, Dependent Children. Continue in Item 11, Remarks, if necessary.

In each row, enter a. Name (Last, First, Middle Initial), b. Date of Birth (YYYYMMDD), c. SSN, d. Relationship (Son, daughter, etc.) and e. Disabled? (Yes/No).

The former spouse is the primary beneficiary; children receive an annuity only if the former spouse remarries before age 55 or dies.

Indicate in block 10.e. if the child is incapable of self support and attach substantiating documentation, if available.

Item 11, Remarks, may be used for comments or additional information not covered in the form.

Items 12 through 15 are self-explanatory. In each, d. Address is (1) Street (Include apartment number), (2) City, (3) State, (4) ZIP Code.

Item 12, Member: enter a. Name (Last, First, Middle Initial), b. SSN, c. Signature and d. Address.

Item 13, Former spouse to be covered: enter a. Name (Last, First, Middle Initial), b. SSN, c. Signature and d. Address.

Item 14, Member's witness: enter a. Name (Last, First, Middle Initial), b. Signature, c. Date signed and d. Address.

Item 15, Former spouse's witness: enter a. Name (Last, First, Middle Initial), b. Signature, c. Date signed and d. Address.

If not received by DFAS within the first year following the date of divorce, the election will be invalid.

When the form has been completed (ensure it is signed by both member and former spouse, and is properly witnessed), submit it to: DFAS - U.S. Military Retirement Pay PO Box 7130 London, KY 40742-7130. Attach a certified copy of the divorce decree, amendment, or other documentation as described in Items 3, 4, and 5.