DD Form 2656-10 "Survivor Benefit Plan (SBP) Former Spouse Request for Deemed Election"

What Is DD Form 2656-10?

DD Form 2656-10, Survivor Benefit Plan (SBP)/Reserve Component (RC) SBP Request for Deemed Election, is used by former spouses to provide information related to SBP coverage or Reserve Component SBP Coverage.

The DD 2656-10 is a part of a series of related documents used for actions related to the SBP, RSFPP, and RCSBP. The form was last released by the Department of Defense (DoD) on July 1, 2020, with all previous editions being obsolete. An up-to-date fillable version of the DD Form 2656-10 is available for download or electronic filing below or can be found on the Executive Services Directorate website.

The form is used strictly for purposes of providing information, following the requirements of 10 U.S.C. Section 1450(f)(3) on SBP coverage. The election is mailed via certified or registered mail to the appropriate Uniformed Service designated agent.

Former spouses must submit DD Form 2656-10 to DFAS with a copy of the divorce decree and court order awarding former spouse SBP, or if a written agreement - if there was one - with the court order incorporating, ratifying, or approving that written agreement in order to request former spouse SBP coverage.

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DD Form 2656-10 Instructions

  1. The DD 2656-10 consists of five sections. Section I, Member Identification, requires identifying information about the eligible service member. That information includes their name, social security number, retirement status and date of retirement, the branch of service, and type of duty.
  2. Section II is for former spouse identification and requires their name, SSN, date of birth, and home address. Box 10 is Section II is for marriage history. This includes the date of marriage, date of divorce, current marital status, and date of the current marriage.
  3. Section III, Authority to Request Deemed SBP Election, consists of three yes or no questions. Box 11 is for stating if the election is made according to the requirements of a court order. Box 12 asks if the election is being made due to a written agreement. Box 13 is for certifying that the written agreement mentioned in the previous question had been approved by a court order. Copies of all court orders, agreements, and supporting documentation must be attached to the form.
  4. Section IV is for listing all dependent children if required by the court order or written agreement (Box 14) and writing down any additional remarks (Box 15).
  5. Section V is for the signature of the former spouse and date of filing.

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SURVIVOR BENEFIT PLAN (SBP) FORMER SPOUSE
OMB No. 0704 - 0569
OMB approval expires
REQUEST FOR DEEMED ELECTION
20230731
The public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-
informationcollections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a
collection of information if it does not display a currently valid OMB control number.
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. Chapter 73, subchapters II and III Survivor Benefit Plan; DoD Instruction 1332.42, Survivor Annuity Program Administration; DoD Financial Management Regulation,
Volume 7B, Chapter 43; and E.O. 9397 (SSN), as amended.
PRINCIPAL PURPOSE(S): Used by a former spouse to deem an election for Former Spouse SBP coverage or Former Spouse Reserve Component (RC) SBP.
ROUTINE USE(S): To former spouses for purposes of providing information, consistent with the requirements of 10 U.S.C. Section 1450(f)(3), regarding SBP or RC-SBP coverage. The
System of Record Notice (SORN) T7347b is published at:
https://www.federalregister.gov/documents/2009/01/07/E9-41/privacy-act-of-1974-systems-of-records
DISCLOSURE: Voluntary; however failure to provide requested information within one year of the date of the court order which requires former spouse SBP coverage will result in denial of
former spouse SBP or RC-SBP coverage.
INSTRUCTIONS
GENERAL.
1. Read these instructions carefully before completing the form. Please print legibly.
2. You must advise the finance center (see Item 3 below for address) of any changes to marital status, your correspondence address, or changes to your
financial institution.
3. Mail your election (it is strongly recommended that you send via certified or registered mail) to the appropriate Uniformed Service designated agency. The
Uniformed Services' designated agents are:
(a) ARMY, NAVY, AIR FORCE and MARINE CORPS: Defense Finance and Accounting Service Garnishment Law Directorate, Post Office Box
998002, Cleveland OH 44199-8002
(b) COAST GUARD: Commanding Officer (LGL), USCG Pay and Personnel Center, 444 S.E. Quincy Street, Topeka, KS 66683-3591
(c) PUBLIC HEALTH SERVICE: Commissioned Corps Headquarters, Compensation Branch, 1101 Wooten Parkway, Suite 300, Rockville, MD 20852
(d) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION: Same as U.S. Coast Guard.
4. This form must be submitted within one year of the date of the court order or written agreement authorizing former spouse coverage.
SECTION I - MEMBER IDENTIFICATION
1. MEMBER NAME
3a. BRANCH OF SERVICE
b. (X one)
(Last, First, Middle Initial)
Air
Army
Navy
Active
Reserve
Force
National
Marine Corps
NOAA
2. SSN or DoDID
Guard
Coast Guard
USPHS
4. IS MEMBER RETIRED?
YES
NO
5. IF KNOWN, ENTER DATE OF MEMBER'S RETIREMENT
(YYYYMMDD)
SECTION II - FORMER SPOUSE IDENTIFICATION
6a. FORMER SPOUSE NAME
7. SSN or DoDID
(as it appears on court order) (Last, First, Middle Initial)
6b.CURRENT NAME
8. ADDRESS (Include ZIP Code)
(Last, First, Middle Initial)
9. DATE OF BIRTH (YYYYMMDD)
10.TELEPHONE NUMBER
11. EMAIL ADDRESS
12. MARRIAGE HISTORY
c. ARE YOU CURRENTLY MARRIED?
a. DATE MARRIED TO MEMBER
b. DATE OF DIVORCE (YYYYMMDD)
d. IF YES, DATE OF CURRENT
MARRIAGE (YYYYMMDD)
(Listed in Item 1 above) (YYYYMMDD)
YES
NO
DD FORM 2656-10, JULY 2020
Page 1 of 2
PREVIOUS EDITION IS OBSOLETE.
SURVIVOR BENEFIT PLAN (SBP) FORMER SPOUSE
OMB No. 0704 - 0569
OMB approval expires
REQUEST FOR DEEMED ELECTION
20230731
The public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-
informationcollections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a
collection of information if it does not display a currently valid OMB control number.
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. Chapter 73, subchapters II and III Survivor Benefit Plan; DoD Instruction 1332.42, Survivor Annuity Program Administration; DoD Financial Management Regulation,
Volume 7B, Chapter 43; and E.O. 9397 (SSN), as amended.
PRINCIPAL PURPOSE(S): Used by a former spouse to deem an election for Former Spouse SBP coverage or Former Spouse Reserve Component (RC) SBP.
ROUTINE USE(S): To former spouses for purposes of providing information, consistent with the requirements of 10 U.S.C. Section 1450(f)(3), regarding SBP or RC-SBP coverage. The
System of Record Notice (SORN) T7347b is published at:
https://www.federalregister.gov/documents/2009/01/07/E9-41/privacy-act-of-1974-systems-of-records
DISCLOSURE: Voluntary; however failure to provide requested information within one year of the date of the court order which requires former spouse SBP coverage will result in denial of
former spouse SBP or RC-SBP coverage.
INSTRUCTIONS
GENERAL.
1. Read these instructions carefully before completing the form. Please print legibly.
2. You must advise the finance center (see Item 3 below for address) of any changes to marital status, your correspondence address, or changes to your
financial institution.
3. Mail your election (it is strongly recommended that you send via certified or registered mail) to the appropriate Uniformed Service designated agency. The
Uniformed Services' designated agents are:
(a) ARMY, NAVY, AIR FORCE and MARINE CORPS: Defense Finance and Accounting Service Garnishment Law Directorate, Post Office Box
998002, Cleveland OH 44199-8002
(b) COAST GUARD: Commanding Officer (LGL), USCG Pay and Personnel Center, 444 S.E. Quincy Street, Topeka, KS 66683-3591
(c) PUBLIC HEALTH SERVICE: Commissioned Corps Headquarters, Compensation Branch, 1101 Wooten Parkway, Suite 300, Rockville, MD 20852
(d) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION: Same as U.S. Coast Guard.
4. This form must be submitted within one year of the date of the court order or written agreement authorizing former spouse coverage.
SECTION I - MEMBER IDENTIFICATION
1. MEMBER NAME
3a. BRANCH OF SERVICE
b. (X one)
(Last, First, Middle Initial)
Air
Army
Navy
Active
Reserve
Force
National
Marine Corps
NOAA
2. SSN or DoDID
Guard
Coast Guard
USPHS
4. IS MEMBER RETIRED?
YES
NO
5. IF KNOWN, ENTER DATE OF MEMBER'S RETIREMENT
(YYYYMMDD)
SECTION II - FORMER SPOUSE IDENTIFICATION
6a. FORMER SPOUSE NAME
7. SSN or DoDID
(as it appears on court order) (Last, First, Middle Initial)
6b.CURRENT NAME
8. ADDRESS (Include ZIP Code)
(Last, First, Middle Initial)
9. DATE OF BIRTH (YYYYMMDD)
10.TELEPHONE NUMBER
11. EMAIL ADDRESS
12. MARRIAGE HISTORY
c. ARE YOU CURRENTLY MARRIED?
a. DATE MARRIED TO MEMBER
b. DATE OF DIVORCE (YYYYMMDD)
d. IF YES, DATE OF CURRENT
MARRIAGE (YYYYMMDD)
(Listed in Item 1 above) (YYYYMMDD)
YES
NO
DD FORM 2656-10, JULY 2020
Page 1 of 2
PREVIOUS EDITION IS OBSOLETE.
MEMBER NAME (Last, First, Middle Initial)
SSN or DODID
SECTION III - AUTHORITY TO REQUEST DEEMED SBP ELECTION
13. IS ELECTION MADE PURSUANT TO REQUIREMENTS OF A COURT ORDER (If 'Yes', attach a copy of the associated
YES
NO
divorce agreement and court order)?
14. IS ELECTION BEING MADE PURSUANT TO WRITTEN AGREEMENT AS PART OF OR INCIDENT TO A PROCEEDING
OF DIVORCE, DISSOLUTION, OR ANNULMENT THAT HAS BEEN INCORPORATED IN, RATIFIED, OR APPROVED BY A
YES
NO
COURT ORDER? (If `Yes', attach a copy of the written agreement and court order).
NOTE: IF YOU ANSWERED `NO' TO BOTH ITEM 13 AND ITEM 14, ABOVE, STOP, YOU ARE NOT ELIGIBLE TO REQUEST A DEEMED SBP ELECTION.
SECTION IV - DEPENDENT CHILDREN INFORMATION
15. WAS CHILD COVERAGE ALSO COURT-ORDERED OR REQUIRED BY A WRITTEN AGREEMENT?
YES
NO
(If you answered 'NO' to item 15, do not complete item 16).
16. LIST DEPENDENT CHILDREN REQUIRED TO BE COVERED BY COURT ORDER/WRITTEN AGREEMENT. (If a court awarded former spouse and
child(ren) coverage, list all of the children of your marriage to the member. In block d., list that child's relationship to the member and with you. For example, 'my
daughter and his stepson')
(e) DISABLED?
b. DATE OF
d. RELATIONSHIP
a. NAME
c. SSN
(Last, First, Middle Initial)
(If 'YES', provide additional
BIRTH
(Son, daughter, stepson, etc.)
(YYYYMMDD)
information in Item 17. REMARKS)
17. REMARKS (Use this space to further explain any item if necessary. Reference by item number.)
SECTION V - FORMER SPOUSE SIGNATURE
18. SIGNATURE
19. DATE SIGNED (YYYYMMDD)
DD FORM 2656-10, JULY 2020
Page 1 of 2
PREVIOUS EDITION IS OBSOLETE.
Page of 2