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

FE 2004

September 2004

Use:

Federal employees use this form for belated FEGLI 2004 Open Season elections to enroll in the FEGLI Program, or to change/increase their existing coverage. Employees must first receive a written determination from their agency human resources office that they are eligible to make a belated FEGLI 2004 Open Season election. After receiving such determination, employees have 31 days in which to elect coverage on this FE-2004.

Electronic Copies:

Adobe Acrobat PDF File [281 KB]

Paper Copies:

Employees:

Download the form locally. However, if you can't access the Adobe-Acrobat PDF fillable form, contact your servicing human resources office for more information on how to obtain a copy.

Agencies:

Agencies can download the form locally. The form should be provided to an employee only after making a determination that he/she is eligible to make a belated Open Season election. If you are unable to download the form, agency headquarters officers may order a limited quantity of forms directly from the Office of Federal Employees' Group Life Insurance (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
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.