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U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

Insurance Services Programs

Federal Employees' Group Life Insurance Program

Statement of Claim, Option C — Family Life Insurance
FE-6 DEP	April 2004

Use:

Used to claim benefits for the death of family members covered by FEGLI Option C coverage.

Electronic Copies:

PDF Fillable (391K File)
This form is best viewed in Adobe 6.0. If you are using Adobe Reader 5.0 and have a problem opening this form, please download the latest version, or do the following:

Using the RIGHT button on your mouse, click on the form link above and select "Save target as" from the resulting menu. Save the form file to your hard drive or a local network drive. Then open the file directly using Adobe Reader 5.0 or above. Doing this, you will avoid opening the file through your internet browser.

Please note: These forms will not open using Adobe Reader 4.0 or 3.0. You will have to load the current Adobe Reader at

Paper Copies:

Employees:

Download the form locally. However, if you can't access the Adobe-Acrobat PDF-fillable form, then request a copy from your servicing human resources office.

Annuitants:

Call toll free 1-888-767-6738 (202-606-0500 in the DC Area), or
Send an email to retire@opm.gov, giving the number of the form that you need and your mailing address, or
Request a copy from a local Federal agency Human Resources Office.

Agencies:

We encourage agencies to download the form locally. However, if you can't access the Adobe Acrobat PDF-fillable form, you can order a limited supply from OFEGLI.

Agency headquarters insurance officers order FE forms directly from OFEGLI. OFEGLI accepts orders by fax and mail only - no telephone orders. The fax number is 201-395-7950 - Attention: Forms Ordering Desk. The mailing address is Office of Federal Employees' Group Life Insurance, Attention: Forms Ordering Desk, P. O. Box 2627, Jersey City, NJ 07303-2627. OFEGLI will need the form number, the quantity, the shipping address and the point of contact, in case of questions.

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