When a civilian employee of the Federal Government passes away, a comprehensive procedure is in place to ensure their unpaid compensation is properly addressed and disbursed to the rightful claimants. The Standard Form 1153 (SF 1153), titled "Claim for Compensation of Deceased Civilian Employee," serves as a crucial document in this process. Approved by the Office of Management and Budget (OMB) under No. 3206-0234, this form guides claimants through the collection of necessary information and submissions to the employing federal agency of the deceased. It requires detail such as the deceased's name, social security number, last known address, date of death, and the employing agency's information. Through various sections designated for different potential claimants—ranging from designated beneficiaries and spouses to next of kin or estate executors—the form meticulously captures data to adjudicate the claim, including whether a designation of beneficiary form (SF 1152) exists, marital status verification, details of potential heirs, and information about funeral expenses. Importantly, it underscores the legal consequences of fraudulent claims and clearly states the information sharing and verification protocols to ensure integrity and compliance with federal laws. This procedure not only encapsulates a testament to the government's commitment to its employees and their families but also emphasizes the need for accuracy, legitimacy, and thoroughness in handling posthumous affairs.
| Question | Answer |
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| Form Name | Standard Form 1153 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | sf 1153 form, opm standard sf claim form, opm standard form 1153, 2011 form compensation |
CLAIM FOR COMPENSATION OF DECEASED CIVILIAN EMPLOYEE |
Form Approved |
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OMB No. |
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GENERAL INFORMATION
•Complete this form and send it to the Federal Government agency that employed the deceased at the time of his/her death. Contact that agency if you need help to complete this form.
•All Government checks in your possession, drawn to the order of the deceased in payment of “unpaid compensation,” should accompany this claim. All Government checks drawn to the order of the deceased for other purposes (such as veterans’ benefits, social security benefits, or Federal tax refunds) should be returned to the agency that sent it.
PART A
1. |
Name of deceased |
2. |
Social Security Number of deceased |
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3. |
Last address of deceased (if known) |
4. |
Date of death |
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5. Employing agency
INSTRUCTIONS
•If you are a designated beneficiary of the deceased, complete Parts B and G.
•If you are the widow or widower of the deceased, complete Parts B, C, and G.
•If you are not a designated beneficiary of the deceased but you are a relative or next of kin of the deceased, complete Parts D and G.
•If you are an executor or administrator of the deceased’s estate, complete Parts E and G.
•If you do not meet the criteria in Items 1 through 4, complete Parts F and G.
PART B
1. Is a Designation of Beneficiary for Unpaid Compensation (SF 1152) on file with the agency?
Yes No
If you need more room, write "See Attached" in Part B. On a blank sheet (the attachment), print your name, date of birth and social security number at the top. List the information required in Part B for each beneficiary. Sign the form and attachment having the same two people witness both of your signatures..
Full Name/Legal entity, e.g., Trust
Social Security
Number
Age
Relationship to deceased
Address
PART C
1. Do you certify that (1) you were married to the deceased and (2) to the best of your knowledge and belief the marriage
was not dissolved prior to his/her death? |
Yes |
No
PART D
1.List below the name, social security number, age, relationship, and address of:
(a)If no widow or widower survives, list each living child of the deceased and state whether natural, adopted, illegitimate or stepchild.
(b)If no child survives, list each living descendant of the deceased children.
(c)If no widow or widower, child or descendant of deceased children survive, list each surviving parent and state whether natural, step, foster, or adoptive parent.
(d)If none of the above survives, list the next of kin who may be capable of inheriting from the deceased (brothers, sisters, descendants of deceased brothers and sisters).
Full name
Social Security
Number
Age
Relationship to deceased
Address
U.S. Office of Personnel Management |
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Standard Form 1153 |
CFR 178, Subpart B |
(continue on other side) |
Revised August 2011 |
NSN |
1153 |
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All other previous editions are not usable |
PART E
1.If none of the individuals listed in Parts B and D survives and an executor or administrator of the deceased’s estate has been appointed, the following statement should be completed.
I/we have been duly appointed |
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of the estate of the deceased, as |
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(Executor or Administrator) |
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evidenced by certificate of appointment herewith, administration having been taken out in the interest of
(Name, address, and relationship of interested relative or creditor)
and such appointment is still in full force and effect.
NOTE: If making claim as the executor or administrator of the estate of the deceased, no witnesses are required, but a court certificate evidencing your appointment must be submitted.
2. If no administrator or executor of the deceased’s estate has been appointed, will one be appointed? Yes
No
PART F
1. Have funeral expenses of the deceased been paid? |
Yes |
No |
(If paid, receipted bill of the funeral director must be attached.) |
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Whose money was used to pay the funeral expenses?
Don’t know
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PART G
Fines, Penalties and Forfeitures are imposed by law for making false or fraudulent claims against the United States or making false statements in connection therewith.
Signature of claimant
Date
Signature of claimant
Date
Street address
Street address
City, State, and Zip Code
City, State, and Zip Code
Two Witnesses are Required
Signature of witness |
Date |
Signature of witness |
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Date
Street address
Street address
City, State, and Zip Code
City, State, and Zip Code
Privacy Act and Public Burden Statement
Solicitation of this information is authorized by the Code of Federal Regulations, Part 178, Subpart B. The information you furnish will be used to determine the amount, validity, and the person(s) entitled to the unpaid compensation of a deceased Federal employee. The information may be shared and is subject to verification, via paper, electronic media, or through the use of computer matching programs to obtain information necessary for determination of entitlement under this program or to report income for tax purposes. It may also be shared and verified, as noted above, with law enforcement agencies when they are investigating a violation or potential violation of the civil or criminal law. Public Law
We think this form takes an average of 15 minutes per response to complete, including the time for reviewing instructions, getting the needed data, and reviewing the completed form. Send comments regarding our estimate or any other aspect of SF 1153, including suggestions for reducing completion time, to the Office of Personnel Management (OPM), Reports and Forms Officer, Paperwork Reduction
U.S. Office of Personnel Management CFR 178, Subpart B
Standard Form 1153 Revised Aug 2011