Federal Employees' Group Life Insurance Program

Agency Certification of Status of Reemployed Annuitants

Use:

Agencies complete this form for any reemployed annuitant who is entitled to elect or continue life insurance as an employee.

Electronic Copies:

• PDF Fillable Version:[28 KB]

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:

Agencies:

This form is available ONLY through downloading from our web site.

Paper copies of this form are NOT available from OPM.