DD Form 2656-7: Verification for Survivor Annuity

In Box 1, enter the deceased member's name (Last, First, Middle Initial), social security number, date of birth (YYYYMMDD), date of death (YYYYMMDD), branch of service and rank/rate.

In Box 2, enter the claimant's name (Last, First, Middle Initial), social security number, date of birth (YYYYMMDD), telephone (include area code) and the country of which you are a citizen.

For i. correspondence address, enter the street, apartment number, city, state and ZIP code.

If you are a nonresident alien, X the box, enter your country of residence, and see the note.

Nonresident aliens are automatically taxed at the rate of 30 percent, unless there is a tax treaty between the United States and the foreign country permitting a lesser rate.

If the country in which the annuitant lives has a tax treaty with the United States, then complete IRS Form W-8BEN, Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding showing the country of residence.

For g. type of benefit claimed, the boxes are SBP, RCSBP and RSFPP.

For h. relationship, X one: spouse, child, former spouse or insurable interest.

The Box 3 section applies to spouse applicants only. For a., mark YES or NO: "I certify that I was legally married to the member on the date of death".

If YES, verify the date of marriage to the member (if blank or incorrect, provide the correct marriage date). If NO, provide the date of divorce (YYYYMMDD).

For b. are there children under age 23 or incapacitated of the deceased member, mark YES or NO. If YES, provide the name (Last, First Middle Initial), SSN and date of birth (YYYYMMDD) for each child.

The annuity may be affected if you are receiving any other military survivor annuity of any kind from this deceased member or any other deceased member. You are obligated to notify DFAS of any other annuities that might affect your entitlement.

For c. are you receiving any other annuity from DFAS based on the military record of any other deceased military retiree, mark YES or NO. If YES, provide the name of the deceased retiree (Last, First, Middle Initial), SSN, coverage type (SBP or RSFPP) and monthly benefit amount.

Box 4 applies to child applicants only. For a. are you married, mark YES or NO. For b., if you are 18 years of age or older, mark YES or NO: are you a full-time student?

The Box 5 section applies to former spouse applicants only. Enter the date of divorce from the deceased member (YYYYMMDD) and the date of remarriage (YYYYMMDD).

Box 6, the statement of understanding about Dependency and Indemnity Compensation (DIC), applies to spouse applicants only. A spouse receiving DIC may not receive the full amount of an annuity under SBP, or RCSBP.

All SBP premiums paid will be refunded if the SBP annuity is not payable because the DIC payment is greater.

For a. have you applied or do you intend to apply to the Veteran's Administration (VA) for benefits, mark YES or NO. If YES, provide the VA claim number, the VA monthly award amount and the mailing address of the VA office handling your account (Street, City, State, ZIP Code).

Box 7 is to be completed by all applicants.

The signature must be that of: the applicant; or for the annuitant by: the custodial natural parent or the legal representative; guardian; or custodian.

Failure to sign will delay payment of the annuity.

Enter the signature of applicant or legal representative (if applicable), and the date signed (YYYYMMDD).

Verify that the information provided is correct, provide any missing information, and line through and correct any errors.

If you have questions or need assistance completing the form, contact DFAS toll-free at 1-800-321-1080.

After verifying the information provided, sign the form and return it to: Defense Finance and Accounting Service, U.S. Military Annuitant Pay, 8899 E. 56th Street, Indianapolis, IN 46249-1300 or fax it to DFAS toll-free at 1-800-982-8459.