SF3104B

Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death (FERS)

Agency
GSA
Revision
Revised April 2012
Fillable fields
290
Pages
18
Official source
GSA form page
Checked
October 20, 2026
Fill SF3104B online
Page 1 of form SF3104B

Standard Form 3104B (SF 3104B): Documentation and Elections for FERS Death Benefits

Standard Form 3104B (SF 3104B), Documentation and Elections in Support of Application for Death Benefits when Deceased was an Employee at the Time of Death, is a U.S. Office of Personnel Management (OPM) forms package for the Federal Employees Retirement System (FERS), Revised April 2012, OMB No. 3206-0172. GSA hosts a copy in its forms library.

The form says the package should be completed if the deceased was an employee under FERS at the time of death. The applicant and the deceased's employing agency each complete parts of it. All applicable forms go to the employing agency with the survivor's Application for Death Benefits, SF 3104, and the agency forwards the application to OPM.

It has six sections: a certified summary of Federal service, the Basic Employee Death Benefit, a health benefits election, post-1956 military service, rollover information with a payment election form, and agency information and certification. OPM estimates an average of 60 minutes per response. You can fill it out free in your browser on this page and download the result without an account.

Top of page 1 of Standard Form 3104B (SF 3104B): Documentation and Elections for FERS Death Benefits, as printed by GSA

What's on SF 3104B

Section 1: Certified Summary of Federal Service

Identification, verified civilian and military service, civilian service not subject to a contributory retirement system, the agency certification and the applicant's certification.

Section 2: Basic Employee Death Benefit

Agency instructions with a table of past amounts, then the benefit due as entered by the agency, payable in a lump sum or 36 monthly installments.

Section 3: Health Benefits Election

The agency checks one of three boxes. Where item 1 is checked, the surviving spouse elects whether to continue the deceased's health benefits enrollment and signs.

Section 4: Post-1956 military service

Information on credit for the service, then the Survivor's Military Service Election: agency facts in Part A, a deposit election in Part B and an election to exclude military service in Part C.

Section 5: rollover and payment election

Rollover option information, a Special Tax Notice Regarding Rollovers, the Death Benefit Payment Election Form and two financial institution certifications.

Section 6: Agency Information and Certification

Retirement coverage, workers' compensation, health and life insurance, a document checklist, the personnel officer's certification and a payroll office checklist.

How SF 3104B is completed

  1. 1

    The agency fills in service and benefit

    The personnel office completes and certifies Section 1 and enters the amount payable in Section 2, so the survivor has the information needed to make the election.

  2. 2

    The applicant reviews the service

    In Part E the applicant certifies the service listed is complete, or checks that the employee had additional service and attaches a signed statement with dates, title and location.

  3. 3

    Make the health benefits election

    If the agency checks item 1 of Section 3, the surviving spouse checks one choice and signs. The form says an election not to continue the enrollment cannot be changed later.

  4. 4

    Return the military service election

    Where Section 4 applies, the survivor reads the information on page 7, makes the election in Part B or C, signs Part D and returns two copies to the office named in Part A, item 7.

  5. 5

    Choose payment and rollover

    On the Death Benefit Payment Election Form, Part 1 picks a lump sum or 36 installments and Part 2 picks one of three options, then the spouse signs the certification.

  6. 6

    The agency certifies and forwards

    The personnel officer and payroll officer complete and sign Section 6. The agency forwards the forms with SF 3104 to OPM.

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Where it goes and what the form says

Where it goes

The form says all applicable forms are submitted to the employing agency of the deceased along with SF 3104, and the agency forwards the application to OPM.

Date for the military election

Part A of the Survivor's Military Service Election has a date the election should be received by, printed as 30 days from the date the form is given to the applicant.

Amount described on the form

Section 2 describes the Basic Employee Death Benefit as $15,000 (increased by Civil Service Retirement System [CSRS] Cost of Living Adjustments [COLAs]), plus 50% of the employee's final annual rate of pay, or average salary if higher.

Rollover amounts printed on the form

The form says OPM will not roll over amounts of less than $200, and that a partial rollover to each IRA, employer plan or Thrift Savings Plan account must be at least $500.

Questions about withholding

The form gives OPM at 1-888-767-6738 and U.S. Office of Personnel Management, Federal Employees Retirement System, P.O. Box 45, Boyers, PA 16017-0045. OPM estimates 60 minutes per response.

Related forms

Who fills out SF 3104B?

  • The agency personnel office

    The deceased's employing agency personnel office completes Section 1, the Certified Summary of Federal Service, Section 2 on the Basic Employee Death Benefit, and its part of Section 3.

  • The applicant

    The applicant signs Part E of Section 1 to certify the service listed is complete, and completes Section 4 on post-1956 military service, if appropriate.

  • Surviving spouse or former spouse

    The surviving spouse, or a surviving former spouse named under a court order, completes the Death Benefit Payment Election Form in Section 5, if appropriate.

  • Payroll office and financial institution

    The personnel and payroll offices complete Section 6. A financial institution or eligible employer plan signs a certification if benefits go to an IRA or employer plan.

The cover page says who completes each section.

Official sources and the blank

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Questions about Form SF3104B

Who issues SF 3104B?

It is printed as an Office of Personnel Management form, Revised April 2012, OMB No. 3206-0172, from the CSRS/FERS Handbook for Personnel and Payroll Offices. GSA hosts a copy in its forms library.

When is SF 3104B used?

The form says it should be completed only if the deceased was a Federal employee under FERS at the time of death. For CSRS coverage, Section 6 says to use SF 2800 in lieu of this form.

Who receives the completed package?

The applicant submits all applicable forms to the employing agency of the deceased with SF 3104. The form says the agency forwards the application to OPM.

Can the Basic Employee Death Benefit be paid in installments?

The form offers a lump sum or 36 monthly installments, chosen in Part 1 of the Death Benefit Payment Election Form. It says the installments total slightly more because interest is paid on them.

What are the rollover options?

Part 2 of the election form has three options: pay benefits eligible for rollover directly, roll all or part into an IRA, eligible employer plan or Thrift Savings Plan account, or have OPM send the complete rollover election package later.

Does SF 3104B give tax advice?

No. The form says questions about the taxability of these benefits go to a qualified tax advisor or the IRS, and that its notice is the only income tax information available from OPM on the subject.