DD Form 2656-5 at a glance
What it is: DD Form 2656-5 is the Reserve Component Survivor Benefit Plan (RCSBP) Election Certificate.
Where and when to file: 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.
Reserve Component members use this form, 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).
A filled-in DD Form 2656-5 example: an unmarried member fills out Section I
How to fill out DD Form 2656-5, box by box
Member information
In SECTION I - MEMBER INFORMATION, enter your name (Last, First, Middle Initial) in Box 1 and your social security number in Box 2.
Enter your rank in Box 3 and your date of birth (YYYYMMDD) in Box 4.
Enter your mailing address (Street, Apartment Number, City, State, and ZIP Code) in Box 5, your telephone number (Include area code) in Box 6 and your email address in Box 5.a.
Spouse and dependent children
Mark YES or NO for Box 7, ARE YOU MARRIED?, and for Box 8, DO YOU HAVE ANY DEPENDENT CHILDREN?
If applicable, in SECTION III - SPOUSE/DEPENDENT CHILD(REN) INFORMATION, enter the SPOUSE'S NAME (Last, First, Middle Initial) in 9.a., the SOCIAL SECURITY NUMBER in b., the DATE OF BIRTH (YYYYMMDD) in c. and the DATE OF MARRIAGE (YYYYMMDD) in Box 10.
In Box 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). For each child enter 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) and e. DISABLED? (Yes/No).
If you have additional dependent children, continue in SECTION VII, REMARKS.
Level of coverage
In Box 14, select the monthly amount of retired pay you wish to have the survivor annuity based on. You cannot decrease the level of existing coverage.
Place an X in the appropriate box to indicate your election: FULL RETIRED PAY, or REDUCED AMOUNT OF RETIRED PAY, which cannot be less than $300.00 and requires spouse concurrence in Section IX (checked November 2, 2026).
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.
Insurable interest beneficiary
In SECTION VI - INSURABLE INTEREST COVERAGE, Box 15, INSURABLE INTEREST BENEFICIARY, enter a. NAME (Last, First, Middle Initial), b. SOCIAL SECURITY NUMBER, c. DATE OF BIRTH (YYYYMMDD), d. MAILING ADDRESS (Street, Apartment Number, City, State, and ZIP Code) and e. RELATIONSHIP TO MEMBER.
Signature of the member and a witness
THE MEMBER'S SIGNATURE MUST BE WITNESSED. The witness cannot be the member's spouse, or beneficiary.
Sign in Box 17, SIGNATURE OF MEMBER, and enter the DATE SIGNED (YYYYMMDD) in Box 18.
The witness enters the PRINTED NAME OF WITNESS (Last, First, Middle Initial) in Box 19.a., signs in b. SIGNATURE, enters the MAILING ADDRESS OF WITNESS (Include ZIP Code) in c. and the DATE SIGNED (YYYYMMDD) in d.
Spouse concurrence and notary
SECTION IX - SPOUSE CONCURRENCE is required when member is married and elects child(ren) only coverage, does not elect full spouse coverage, or declines coverage.
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. 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.
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. Sign in a. SIGNATURE and enter the DATE SIGNED (YYYYMMDD) in b.
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.
In 21. NOTARY WITNESS, the notary public signs (Signature of Notary), fills in My commission expires and the NOTARY SEAL.
More rules for DD Form 2656-5
Disclosure is 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.
In Box 12, OPTIONS (Select one), Option A: I decline to make an election until age 60. (Do not select type of coverage.) Selecting Option A or Option B requires spouse concurrence in Section IX.
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.)
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.)
Box 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 VII - REMARKS, 16: use this section to continue an item or make additional comments.
Common questions about DD Form 2656-5
Does it need a notary?
The spouse's signature must be notarized. A notary public must witness the spouse's signature. The witness must not be a beneficiary of the member.
Where do I file it?
Complete this form and submit it to your service using the address listed for your service. A telephone number is provided if you have questions about the program or need assistance completing this form. If your service is Army Reserve/ Army National Guard, mail this form to HRC-Ft. Knox ATTN: AHRC-PDR-RC 1600 Spearhead Division Ave. Ft. Knox, KY 40122. If your service is Navy Reserve, mail this form to Navy Personnel Command (PERS-912) 5720 Integrity Drive Millington, TN 38055-9120. If your service is Air Force Reserve/ Air National Guard, mail this form to HQ ARPC/DPPE 6760 E. Irvington Place Denver, CO 80280-4000. If your service is Marine Corps Reserve, mail this form to Headquarters U.S. Marine Corps Manpower and Reserve Affairs (MMSR-5) 3280 Russell Road Quantico, VA 22134-5103.
Sources
[1] DD Form 2656-5 (AUG 2011), Reserve Component Survivor Benefit Plan (RCSBP) Election Certificate, Washington Headquarters Services (the Official source link on this page).