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

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Insurance Services Programs

Federal Employees' Group Life Insurance Program

Request for Insurance

SF 2822
January 2002


Federal employees use this form to obtain life insurance coverage by providing medical information.

Electronic Copies:

To use the Adobe Acrobat forms you need the commercial Acrobat software or the free downloadable Acrobat Reader. You can fill in this form on your computer screen before you print it.

Paper Copies:

Paper copies of this form are not available. You MUST use the downloadable Adobe Acrobat PDF version.