If your agency is participating in Employee Express you can enroll online without using this form.
You do not use this form to enroll. See our annuitant FEHB enrollment instructions.
Employees may use this form to:
This form is available as a screen-fillable Adobe Acrobat PDF file. Using the free downloadable Adobe Acrobat reader you may complete the form on the screen and then print it out already completed. Note, however, that if you are using the free Acrobat reader software you cannot save the form with the information that you have typed in it on the screen. You need the commercial Adobe Acrobat program in order to save the form with the data. More information is available in our Adobe Acrobat forms help screen.
This is a large form, with nine pages of instructions followed by a five page form. The full form is a 493K PDF file. Some people have had problems using this large of a form on their computers. Make sure you allow it to download completely before you start to use it.
Accessible Acrobat Version
The first nine pages of this form consists of instructions. We have posted these instructions as an accessible HTML file.
The actual form is on page 10. It is a five page form consisting of 5 copies of that page. You only need to fill out the first copy (page 10) of the form. The other four copies are automatically completed with a duplicate of what you enter on the first copy. Print the form after you finish filling it in on the screen. Remember that if you are using the free Acrobat Reader to complete the form you cannot save it with the information that you entered in the form. You must print it out before you close the form.
Adobe Acrobat Versions 3, 4 and 5
Go to the OPM forms page and open the form as follows:
Adobe Acrobat Versions 6 and 7