SF3104B – Documentation & Elections for FERS Death Benefits (Fillable PDF)

The SF3104B is the official Government form used to document elections and provide information when a Federal employee covered by the Federal Employees Retirement System (FERS) passes away. Survivors use this form to choose health‑benefit options, elect payment methods, and request any applicable deposits.

What Is the SF3104B Form?

SF3104B, Documentation and Elections in Support of Application for Death Benefits, is part of the survivor‑benefit package that must be submitted with the main SF3104 application. The form is available as a fillable PDF, allowing you to type directly into each field without printing first.

Who Must Complete SF3104B?

• Surviving spouse, child, or other eligible beneficiary of a deceased FERS employee.
• Anyone acting as a legal representative for the survivor.
• Any party needing to make elections regarding health coverage, deposit of service credit, or payment method for death benefits.

How to Fill Out the Form Using Formize

Instead of downloading the PDF and opening it in a separate editor, simply click the "Fill out this form" button on this page. The Formize PDF Filler app will load in your browser, letting you complete the form instantly.

Common Mistakes to Avoid

• Leaving required fields blank: Every field marked with an asterisk (*) must be completed.
• Incorrect dates: Use the MM/DD/YYYY format and double‑check the date of death.
• Mismatched signatures: The survivor’s signature must match the name entered on the form.
• Submitting an outdated version: Use the current PDF (revision date 04/2012) linked below.

Where to Submit the Completed Form

After you’ve saved the completed SF3104B, attach it to the survivor’s application package and mail it to the Office of Personnel Management (OPM) at the address provided in the instructions, or submit electronically if your agency permits electronic filing.

Download the official fillable PDF (SF3104B)