Dd Form 2656 5 PDF Details

The DD Form 2656-5, known as the Reserve Component Survivor Benefit Plan (RCSBP) Election Certificate, plays a critical role for members of the Reserve Component in managing the financial future of their beneficiaries. Under the authority of various legal and regulatory sources, including 10 U.S.C. Chapter 73, DoD Instruction 1332.42, and others, this form enables Reserve members to elect how they wish to provide for their survivors during the critical 90-day period after being notified of eligibility for Reserve retired pay. The decision to participate in the RCSBP by choosing between Options B (Deferred Annuity) and C (Immediate Annuity), or to decline coverage, carries lasting implications for both the service member and their designated beneficiaries. It is a choice that cannot be altered unless permitted by specific legal exceptions. The form also requires detailed information about the member, their marital and dependency status, and their chosen level of coverage, ensuring that all necessary details are captured to facilitate the correct processing of survivor benefits. In instances where the selected coverage impacts a spouse, their concurrence is mandatory, demonstrated through required sections of the form that must be completed with utmost accuracy to ensure the intended future security of survivors.

QuestionAnswer
Form NameDd Form 2656 5
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesb rcsbp pdf, dd form 2656 5 aug 2011, dd 2656 5, dd265

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RESERVE COMPONENT SURVIVOR BENEFIT PLAN (RCSBP) ELECTION CERTIFICATE

PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. Chapter 73, subchapters II and III; DoD Instruction 1332.42, Survivor Annuity Program Administration; DoD Financial Management Regulation, Volume 7B, Chapter 54; and E.O. 9397 (SSN).

PRINCIPAL PURPOSE(S): Used by Reserve Component members, during the 90 day period after receiving notification of eligibility to receive Reserve retired pay, to make an election for the Reserve Component Survivor Benefit Plan (RCSBP).

ROUTINE USE(S): None.

DISCLOSURE: Voluntary; however, failure to provide requested information may result in an incorrect election and/or delayed payment of survivor benefits in the event of the member's death.

INSTRUCTIONS

The decision you make regarding participation in the Reserve Component Survivor Benefit Plan (RCSBP) is very important.

A decision to participate, that is to select either Option B or C, is permanent and cannot be changed unless authorized by law, such as the opportunity to terminate your participation during the period that is between your 62nd birthday and the day before you reach age 63 at which time you may elect to discontinue participation. A decision to decline RCSBP coverage means you will not have another opportunity to select SBP coverage until age 60. In the event you decline RCSBP coverage and die prior to your 60th birthday, no survivor benefits will be paid. Please review the program details carefully and consider the effects of your decision before making an election. You must submit this form within the 90-day period after being notified of eligibility for retired pay at age 60. If you do not submit this form as required, your election, if any, will be determined by law.

Complete this form and submit it to your service using the address listed below. A telephone number is provided if you have questions about the program or need assistance completing this form.

IF YOUR SERVICE IS:

MAIL THIS FORM TO:

FOR QUESTIONS CALL:

 

 

 

ARMY RESERVE/

HRC-Ft. Knox

1-888-276-9472

ARMY NATIONAL GUARD

ATTN: AHRC-PDR-RC

or

 

1600 Spearhead Division Ave.

(502) 613-8950

 

Ft. Knox, KY 40122

 

 

 

 

NAVY RESERVE

Navy Personnel Command (PERS-912)

1-877-807-8199

 

5720 Integrity Drive

or

 

Millington, TN 38055-9120

(901) 874-4304

 

 

 

AIR FORCE RESERVE/

HQ ARPC/DPPE

1-800-525-0102

AIR NATIONAL GUARD

6760 E. Irvington Place

Ask for Entitlements Division

 

Denver, CO 80280-4000

 

 

 

 

 

MARINE CORPS RESERVE

Headquarters U.S. Marine Corps

1-800-336-4649

 

Manpower and Reserve Affairs (MMSR-5)

or

 

3280 Russell Road

(703) 784-9306/9307

 

Quantico, VA 22134-5103

 

 

 

 

SECTION I - MEMBER INFORMATION

1.NAME (Last, First, Middle Initial)

2. SOCIAL SECURITY NUMBER

3. RANK

4. DATE OF BIRTH (YYYYMMDD)

5.MAILING ADDRESS (Street, Apartment Number, City, State, and ZIP Code)

6.TELEPHONE NUMBER (Include area code)

5.a. EMAIL ADDRESS

SECTION II - MARITAL/DEPENDENCY STATUS

7. ARE YOU MARRIED?

YES

NO

8. DO YOU HAVE ANY DEPENDENT CHILDREN?

YES

NO

SECTION III - SPOUSE/DEPENDENT CHILD(REN) INFORMATION (If applicable)

9.a. SPOUSE'S NAME (Last, First, Middle Initial)

b.SOCIAL SECURITY NUMBER

c.DATE OF BIRTH (YYYYMMDD)

10.DATE OF MARRIAGE (YYYYMMDD)

11.DEPENDENT CHILDREN. Complete this section for your unmarried, dependent children who are under age 18, or under age 22 if full time students, or any age if disabled and incapable of self-support before age 18 (or 22 if a full time student).

a.CHILD'S NAME (Last, First, Middle Initial)

b. SOCIAL SECURITY NUMBER

c. DATE OF BIRTH (YYYYMMDD)

d. RELATIONSHIP (Son, daughter, stepson, etc.) (Indicate "FS" if from previous marriage)

e.DISABLED?

(Yes/No)

IF YOU HAVE ADDITIONAL DEPENDENT CHILDREN, CONTINUE IN SECTION VII, REMARKS, AND X HERE

DD FORM 2656-5, AUG 2011

PREVIOUS EDITION IS OBSOLETE.

Page 1 of 3 Pages

Adobe Professional 8.0

MEMBER NAME (Last, First, Middle Initial)

SSN

SECTION IV - COVERAGE

12.OPTIONS (Select one) NOTE: Selecting Option A or Option B requires spouse concurrence in Section IX. OPTION A. I decline to make an election until age 60. (NOTE: Do not select type of coverage below.)

OPTION B (DEFERRED ANNUITY). I elect to provide an annuity beginning on the 60th anniversary of my birth should I die before that date, or on the day after date of death should I die on or after my 60th birthday. (Select type of coverage below.)

OPTION C (IMMEDIATE ANNUITY). I elect to provide an immediate annuity beginning on the day after date of my death, whether before or after age 60. (Select type of coverage below.)

13.TYPE OF COVERAGE (Select one)

SPOUSE ONLY.

SPOUSE AND CHILD(REN). CHILD(REN) ONLY.

FORMER SPOUSE (Complete DD 2656-1, "Survivor Benefit Plan (SBP) Election Statement for Former Spouse Coverage").

FORMER SPOUSE AND CHILD(REN) (Complete DD 2656-1,"Survivor Benefit Plan (SBP) Election Statement for Former Spouse Coverage").

NATURAL PERSON WITH AN INSURABLE INTEREST (Complete Section VI).

SECTION V - LEVEL OF COVERAGE

14.Select the monthly amount of retired pay you wish to have the survivor annuity based on. NOTE: You cannot decrease the level of existing coverage. Your covered spouse beneficiary will receive an annuity that will pay 55 percent of the level of coverage until age 62 and will pay between 45 to 50 percent during the phase-out of the two-tier method (October 2005 - March 2008). Effective April 1, 2008, the annuity regardless of age will be 55 percent of the level of coverage selected. The annuity paid to a child or children totals 55 percent (divided in equal shares). Children annuities are payable to children who are: under age 18; or under age 22 if full time, unmarried students; or any age if disabled and incapable of self-support before 18 (or 22, if while a full-time student). An insurable interest annuity is 55 percent of the difference between retired pay and the premium for coverage. Insurable interest annuities remain at 55 percent regardless of age. Place an X in the appropriate box to indicate your election.

FULL RETIRED PAY.

REDUCED AMOUNT OF RETIRED PAY (Cannot be less than $300.00)

$

 

(NOTE: Spouse concurrence required in

 

Section IX.)

 

 

 

 

 

 

SECTION VI - INSURABLE INTEREST COVERAGE

15.INSURABLE INTEREST BENEFICIARY a. NAME (Last, First, Middle Initial)

b. SOCIAL SECURITY NUMBER

c.DATE OF BIRTH (YYYYMMDD)

e. RELATIONSHIP TO MEMBER

d.MAILING ADDRESS (Street, Apartment Number, City, State, and ZIP Code)

SECTION VII - REMARKS

16. USE THIS SECTION TO CONTINUE AN ITEM OR MAKE ADDITIONAL COMMENTS.

DD FORM 2656-5, AUG 2011

Page 2 of 3 Pages

MEMBER NAME (Last, First, Middle Initial)

SSN

SECTION VII - REMARKS (Continued)

16.(Continued)

SECTION VIII - MEMBER SIGNATURE

THE MEMBER'S SIGNATURE MUST BE WITNESSED. The witness cannot be the member's spouse, or beneficiary.

17. SIGNATURE OF MEMBER

18. DATE SIGNED (YYYYMMDD)

 

 

19.a. PRINTED NAME OF WITNESS (Last, First, Middle Initial)

b. SIGNATURE

c. MAILING ADDRESS OF WITNESS (Include ZIP Code)

d. DATE SIGNED (YYYYMMDD)

SECTION IX - SPOUSE CONCURRENCE

(Required when member is married and elects child(ren) only coverage, does not elect full spouse coverage, or declines coverage. The date of the spouse's signature in item 20.b. MUST NOT be before the date of the member's signature in item 18, above. The spouse's signature MUST be notarized.)

Spousal consent and signature are required for an RCSBP election that does not provide for an immediate spouse annuity (Option C) based on full retired pay. A NOTARY PUBLIC MUST WITNESS THE SPOUSE'S SIGNATURE. The witness must not be a beneficiary of the member. In the event that consent is required, but not provided, RCSBP coverage will be established for an immediate spouse annuity based on full retired pay. NOTE: If the member selects Option A (declining to make an election until age 60), and the spouse consents, no annuity will be payable if the member dies prior to reaching age 60. When the member reaches age 60, an SBP election for less than a full spouse annuity requires the member's spouse to consent. Electing Option B requires the beneficiary to wait until the member would have been age 60 before the annuity is payable, in the event the member dies prior to reaching age 60.

20. SPOUSE.

I hereby consent in my spouse's RCSBP election as indicated. I have read and understand the information that explains the options available and the effects of those options. I am aware that my signature constitutes consent and that I may not change my mind at a later date regarding the RCSBP election.

a. SIGNATURE

b. DATE SIGNED (YYYYMMDD)

21. NOTARY WITNESS

 

 

 

 

 

 

 

 

On this

day of

,

, before me, the undersigned notary public,

 

 

 

 

 

 

 

 

 

 

 

personally appeared

 

 

 

 

 

, provided to me through satisfactory evidence

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Name of Spouse (block 20.a.))

 

 

 

of identification, which were

 

 

 

 

 

, to be the person

 

 

 

 

 

 

 

 

 

 

 

whose name is signed in block 20.a. of this document in my presence.

 

 

My commission expires:

 

(Signature of Notary)

 

 

 

NOTARY SEAL

 

DD FORM 2656-5, AUG 2011

 

 

 

Page 3 of 3 Pages

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1. The dd form 2656 5 aug 2011 needs specific details to be entered. Ensure that the subsequent blank fields are filled out:

Stage # 1 in submitting da form 2656 5

2. After performing this section, go on to the subsequent stage and fill out the necessary details in these blanks - MEMBER NAME Last First Middle, SSN, SECTION IV COVERAGE, OPTIONS Select one NOTE Selecting, OPTION A I decline to make an, OPTION B DEFERRED ANNUITY I elect, OPTION C IMMEDIATE ANNUITY I elect, TYPE OF COVERAGE Select one, SPOUSE ONLY, SPOUSE AND CHILDREN, CHILDREN ONLY, FORMER SPOUSE Complete DD, FORMER SPOUSE AND CHILDREN, NATURAL PERSON WITH AN INSURABLE, and SECTION V LEVEL OF COVERAGE.

A way to fill out da form 2656 5 step 2

3. In this step, look at Select the monthly amount of, FULL RETIRED PAY, REDUCED AMOUNT OF RETIRED PAY, NOTE Spouse concurrence required, SECTION VI INSURABLE INTEREST, INSURABLE INTEREST BENEFICIARY a, b SOCIAL SECURITY NUMBER, c DATE OF BIRTH YYYYMMDD, d MAILING ADDRESS Street Apartment, e RELATIONSHIP TO MEMBER, SECTION VII REMARKS, and USE THIS SECTION TO CONTINUE AN. All of these should be filled in with highest precision.

SECTION VI INSURABLE INTEREST, Select the monthly amount of, and NOTE Spouse concurrence required inside da form 2656 5

Regarding SECTION VI INSURABLE INTEREST and Select the monthly amount of, ensure you take a second look here. Both of these are the most important fields in the PDF.

4. It's time to fill in this next segment! Here you will have all of these MEMBER NAME Last First Middle, SSN, SECTION VII REMARKS Continued, Continued, SECTION VIII MEMBER SIGNATURE, THE MEMBERS SIGNATURE MUST BE, SIGNATURE OF MEMBER, DATE SIGNED YYYYMMDD, a PRINTED NAME OF WITNESS Last, and b SIGNATURE form blanks to fill in.

Writing segment 4 of da form 2656 5

5. The last point to finish this form is crucial. Make sure to fill in the necessary form fields, including a PRINTED NAME OF WITNESS Last, b SIGNATURE, c MAILING ADDRESS OF WITNESS, d DATE SIGNED YYYYMMDD, SECTION IX SPOUSE CONCURRENCE, Spousal consent and signature are, SPOUSE I hereby consent in my, a SIGNATURE, b DATE SIGNED YYYYMMDD, NOTARY WITNESS, On this, day of, and before me the undersigned notary, before finalizing. If you don't, it could contribute to a flawed and probably invalid document!

da form 2656 5 conclusion process explained (stage 5)

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