DD Form 2656-6 "Reserve Component Survivor Benefit Plan (RCSBP) Election Certificate"

What Is DD Form 2656-6?

DD Form 2656-6, SBP Election Change Certificate is a form used by a retired army member to change a Survivor Benefit Plan election. A Retired Soldier may elect a new insurable interest beneficiary within 180 days of the death of the previous beneficiary. The retiree must live two years past the effective date of the election for it to be valid. The premiums for the new insurable interest beneficiary will be based on the age of that beneficiary.

The form was last revised by the Department of Defense (DoD) on July 1, 2020. An up-to-date fillable version of the DD Form 2656-6 is available for download and digital filing through the link below or can be found on the DoD Executive Services Directorate website.

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DD Form 2656-6 Instructions

The form is used for changing an SBP election. The completed DD 2656-6 and all applicable paperwork (marriage certificates, birth certificates, divorce decrees) must be sent to the appropriate agency listed below:

  1. Army, Navy, Air Force and Marine Corps retirees send their paperwork to the Defense Finance and Accounting Service, US Military Retirement Pay, PO Box 7130, London, KY 40742-7130
  2. Public Health Service retirees send forms to the U.S. Public Health Service/Commissioned Corps, 5600 Fishers Lane, Room 4-50, Rockville, MD 20857-0001.

Section I, Member Information consists of 6 Boxes and requires personal identifying information about the service member. Boxes 1 and 2 are for the name and social security number, Boxes 3 and 4 are for providing the date of retirement and date of birth. Boxes 5 and 6 require the service member's full mailing address and telephone number (with area code) respectively.

Section II describes the current coverage. The retiree must choose if their current coverage is spouse or child-only, spouse-and-child coverage, insurable coverage, former spouse or former spouse-and-child coverage, suspended coverage or no coverage at all.

Section III provides a list of conditions that trigger eligibility to change coverage for the retiree to choose from. These include marriage, remarriage, acquiring a dependent child, divorce or death of a spouse.

Section IV requires the person filing to indicate their new requested type of coverage.

Section V specifies the level of coverage and Section VI provides information about the spouse or children. This includes their full names, social security numbers, dates of birth and - for dependent children - the relationship between the retiree and disability status.

Section VII calls for the signature of the service member and witness - a notary public or SBP counselor, and includes the witnesses printed name, signature, mailing address and date of commission expiration.

DD 2656-6 Related Forms

  1. DD Form 2656, Data for Payment of Retired Personnel - the main form in the DD 2656 Forms series - is used to elect a Survivor Benefit Plan and designate beneficiaries for receiving retired pay.
  2. DD Form 2656-1, SBP Election Statement for Former Spouse Coverage is a form used by former and present spouses of soldiers for purposes of providing information on SBP benefits.
  3. DD Form 2656-2, SBP Termination Request is used to discontinue participation in the Uniformed Services SBP.
  4. DD Form 2656-5, RCSBP Election Certificate is a form used by Reserve Component Members for electing a Reserve Component Survivor Benefit Plan during the 90-day period after receiving notification of eligibility to claim retired pay.
  5. DD Form 2656-7, Verification for Survivor Annuity is used by spouses and dependent children to verify eligibility for an annuity under the SBP, Retired Servicemen Family Protection Plan or RCSBP.
  6. DD Form 2656-8, SBP Automatic Coverage Fact Sheet is a form used to determine service members' marital and dependency status in order to establish and maintain a retired pay account.
  7. DD Form 2656-10, SBP/RC SBP Request for Deemed Election is a document used by former spouses to provide information related to SBP coverage.
  8. DD Form 2656-11, Statement Certifying Number of Months of SBP Premiums Paid is a form used by individual disagrees with the number of months credited toward Paid-up SBP by the DFAS.
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OMB No. 0704 - 0569
RESERVE COMPONENT SURVIVOR BENEFIT PLAN (RCSBP) ELECTION CERTIFICATE
OMB approval expires
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 Survival 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 uniformed service retirees to change their Survivor Benefit Plan election upon certain events occurring.
ROUTINE USE(S): 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 the requested information may result in an incorrect election and/or delayed payment of survivor benefits in the event of the
member's death.
INSTRUCTIONS
The decision you make regarding participation in the Reserve Component Survivor Benefit Plan (RCSBP) is very important.
A decision to participate, that is to select either Option B or C, is permanent and cannot be changed unless authorized by law, such as the opportunity to terminate your
participation during the period that is between your 62nd birthday and the day before you reach age 63 at which time you may elect to discontinue participation. A decision to decline
RCSBP coverage means you will not have another opportunity to select SBP coverage until age 60. In the event you decline RCSBP coverage and die prior to your 60th birthday, no
survivor benefits will be paid. Please review the program details carefully and consider the effects of your decision before making an election. You must submit this form within the 90-
day period after being notified of eligibility for retired pay at age 60. If you do not submit this form as required, your election, if any, will be determined by law.
Complete this form and submit it to your service using the address listed below. A telephone number is provided if you have questions about the program or need assistance completing
this form.
SECTION I - MEMBER INFORMATION
1. NAME (Last, First, Middle Initial)
2. SSN
3. DATE OF RETIREMENT
4. DATE OF BIRTH
(YYYYMMDD)
(YYYYMMDD)
5. MAILING ADDRESS (Street, Apartment Number, City, State, and ZIP Code)
6. TELEPHONE NUMBER (Include area code)
7. EMAIL ADDRESS
SECTION II - CURRENT COVERAGE
8. MY CURRENT COVERAGE IS: (X one)
NO COVERAGE
SPOUSE ONLY
CHILD ONLY
SPOUSE AND CHILD
INSURABLE INTEREST
FORMER SPOUSE
FORMER SPOUSE AND CHILD
SUSPENDED COVERAGE (See note)
NOTE: Suspended coverage occurs when the member loses his/her spouse beneficiary to death or divorce; or his/her former spouse beneficiary remarries before age 55; or his/her
children exceed the age for eligibility, unless that child is incapacitated.
SECTION III - CONDITIONS THAT TRIGGER ELIGIBILITY TO CHANGE COVERAGE
9. I AM REQUESTING A CHANGE IN COVERAGE BASED ON: (X all that apply)
MARRIAGE. A member, who does not have a spouse at the time of initial eligibility, may provide SBP for the first spouse acquired after retirement by electing coverage
before the first anniversary of that marriage. Coverage and cost begin on the first anniversary of the marriage (coverage begins immediately upon the birth of a child to the
member and spouse beneficiary).
REMARRIAGE. A member whose spouse coverage is suspended due to death of the spouse or divorce, has three options upon remarriage (choose one option only by
placing an X in the appropriate block):
(1) Resume existing level of coverage for my new spouse (X appropriate block in Section IV);
(2) Increase existing level of coverage - up to full retired pay (Complete Section IV);
(3) Not resume any SBP coverage for my new spouse (Complete Sections VI and VII). Please note that spouse concurrence is required to elect this option (Complete
section VIII).
The following additional option is available for members who have former spouse coverage, who remarry and the member is allowed to discontinue that coverage:
(1) Resume existing level of coverage for my new spouse (X appropriate block in Section IV);
NOTE: An election in Section V which increases my initial level of coverage will result in an amount owed that is equal to the difference between the amount of SBP costs that would
have been incurred if the new level of coverage had originally been elected and the amount of SBP costs that I have incurred to date, plus interest. I understand that payment of the
amount owed must be made prior to the first anniversary of the remarriage. I also understand that although this election must be submitted within the first year of marriage, my new
spouse will not be an eligible SBP beneficiary until the first anniversary of our marriage (or upon the birth of our child born after the date of our marriage, if earlier). My failure to notify
DFAS or the PHS payroll office, as appropriate, of my SBP decision will result in automatic coverage at the previous level and a debt for monthly premiums will accrue beginning upon
the first anniversary of our marriage. In the event of my death, payment of the monthly premium debt must be completed before my spouse will receive payment of the SBP annuity.
ACQUIRING A DEPENDENT CHILD. A member who does not have a dependent child at the time of initial eligibility for SBP may elect coverage for a dependent child
within the one-year period after acquiring the first dependent child.
DIVORCE. A member with spouse coverage who divorces, AND who does not elect former spouse coverage, is automatically in a "Suspended Coverage" status. To elect
former spouse coverage, submit DD Form 2656-1, "Former Spouse Election Certificate".
DEATH OF SPOUSE. A member with spouse coverage, who subsequently loses that spouse to death, must select "Suspend Coverage" in Section IV. Reminder: Death
does not permanently terminate SBP spouse coverage. Coverage and costs are simply suspended pending future events.
NOTE: If either "Divorce" or "Death of Spouse" is selected, and the member had previously elected spouse and child coverage, the coverage would convert to "Child
Only" coverage if the member has an eligible child. Exception: In the event of divorce and the member is required to provide former spouse coverage.
Page 1 of 2
DD FORM 2656-6, JULY 2020
PREVIOUS EDITION IS OBSOLETE.
OMB No. 0704 - 0569
RESERVE COMPONENT SURVIVOR BENEFIT PLAN (RCSBP) ELECTION CERTIFICATE
OMB approval expires
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 Survival 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 uniformed service retirees to change their Survivor Benefit Plan election upon certain events occurring.
ROUTINE USE(S): 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 the requested information may result in an incorrect election and/or delayed payment of survivor benefits in the event of the
member's death.
INSTRUCTIONS
The decision you make regarding participation in the Reserve Component Survivor Benefit Plan (RCSBP) is very important.
A decision to participate, that is to select either Option B or C, is permanent and cannot be changed unless authorized by law, such as the opportunity to terminate your
participation during the period that is between your 62nd birthday and the day before you reach age 63 at which time you may elect to discontinue participation. A decision to decline
RCSBP coverage means you will not have another opportunity to select SBP coverage until age 60. In the event you decline RCSBP coverage and die prior to your 60th birthday, no
survivor benefits will be paid. Please review the program details carefully and consider the effects of your decision before making an election. You must submit this form within the 90-
day period after being notified of eligibility for retired pay at age 60. If you do not submit this form as required, your election, if any, will be determined by law.
Complete this form and submit it to your service using the address listed below. A telephone number is provided if you have questions about the program or need assistance completing
this form.
SECTION I - MEMBER INFORMATION
1. NAME (Last, First, Middle Initial)
2. SSN
3. DATE OF RETIREMENT
4. DATE OF BIRTH
(YYYYMMDD)
(YYYYMMDD)
5. MAILING ADDRESS (Street, Apartment Number, City, State, and ZIP Code)
6. TELEPHONE NUMBER (Include area code)
7. EMAIL ADDRESS
SECTION II - CURRENT COVERAGE
8. MY CURRENT COVERAGE IS: (X one)
NO COVERAGE
SPOUSE ONLY
CHILD ONLY
SPOUSE AND CHILD
INSURABLE INTEREST
FORMER SPOUSE
FORMER SPOUSE AND CHILD
SUSPENDED COVERAGE (See note)
NOTE: Suspended coverage occurs when the member loses his/her spouse beneficiary to death or divorce; or his/her former spouse beneficiary remarries before age 55; or his/her
children exceed the age for eligibility, unless that child is incapacitated.
SECTION III - CONDITIONS THAT TRIGGER ELIGIBILITY TO CHANGE COVERAGE
9. I AM REQUESTING A CHANGE IN COVERAGE BASED ON: (X all that apply)
MARRIAGE. A member, who does not have a spouse at the time of initial eligibility, may provide SBP for the first spouse acquired after retirement by electing coverage
before the first anniversary of that marriage. Coverage and cost begin on the first anniversary of the marriage (coverage begins immediately upon the birth of a child to the
member and spouse beneficiary).
REMARRIAGE. A member whose spouse coverage is suspended due to death of the spouse or divorce, has three options upon remarriage (choose one option only by
placing an X in the appropriate block):
(1) Resume existing level of coverage for my new spouse (X appropriate block in Section IV);
(2) Increase existing level of coverage - up to full retired pay (Complete Section IV);
(3) Not resume any SBP coverage for my new spouse (Complete Sections VI and VII). Please note that spouse concurrence is required to elect this option (Complete
section VIII).
The following additional option is available for members who have former spouse coverage, who remarry and the member is allowed to discontinue that coverage:
(1) Resume existing level of coverage for my new spouse (X appropriate block in Section IV);
NOTE: An election in Section V which increases my initial level of coverage will result in an amount owed that is equal to the difference between the amount of SBP costs that would
have been incurred if the new level of coverage had originally been elected and the amount of SBP costs that I have incurred to date, plus interest. I understand that payment of the
amount owed must be made prior to the first anniversary of the remarriage. I also understand that although this election must be submitted within the first year of marriage, my new
spouse will not be an eligible SBP beneficiary until the first anniversary of our marriage (or upon the birth of our child born after the date of our marriage, if earlier). My failure to notify
DFAS or the PHS payroll office, as appropriate, of my SBP decision will result in automatic coverage at the previous level and a debt for monthly premiums will accrue beginning upon
the first anniversary of our marriage. In the event of my death, payment of the monthly premium debt must be completed before my spouse will receive payment of the SBP annuity.
ACQUIRING A DEPENDENT CHILD. A member who does not have a dependent child at the time of initial eligibility for SBP may elect coverage for a dependent child
within the one-year period after acquiring the first dependent child.
DIVORCE. A member with spouse coverage who divorces, AND who does not elect former spouse coverage, is automatically in a "Suspended Coverage" status. To elect
former spouse coverage, submit DD Form 2656-1, "Former Spouse Election Certificate".
DEATH OF SPOUSE. A member with spouse coverage, who subsequently loses that spouse to death, must select "Suspend Coverage" in Section IV. Reminder: Death
does not permanently terminate SBP spouse coverage. Coverage and costs are simply suspended pending future events.
NOTE: If either "Divorce" or "Death of Spouse" is selected, and the member had previously elected spouse and child coverage, the coverage would convert to "Child
Only" coverage if the member has an eligible child. Exception: In the event of divorce and the member is required to provide former spouse coverage.
Page 1 of 2
DD FORM 2656-6, JULY 2020
PREVIOUS EDITION IS OBSOLETE.
MEMBER NAME (Last, First, Middle Initial)
2. SSN
SECTION IV - REQUESTED CHANGE TO COVERAGE
10. PLACE AN X IN THE APPROPRIATE BOX TO INDICATE YOUR ELECTION. NOTE: If you are changing to former spouse coverage, disregard this form. Instead, submit
DD Form 2656-1, "Former Spouse Election Certificate".
RESUME EXISTING COVERAGE. (Complete Sections VI and VII below.)
SPOUSE ONLY. (Complete Sections V through VII below.)
SPOUSE AND CHILD(REN). (Complete Sections V through VII below.)
CHILD(REN) ONLY. (Complete Sections V through VII below.)
SUSPEND COVERAGE. (Complete Section VII below.)
SECTION V - LEVEL OF COVERAGE
11. If this is an initial election (or if increasing the level of coverage following remarriage), select the monthly amount of retired pay you wish to have the survivor annuity
based on. NOTE: You cannot decrease the level of existing coverage. Your covered spouse beneficiary will receive an annuity that will pay 55 percent of the level of
coverage you select until their age 62 and will pay between 45 to 50 percent during the phase-out of the two-tier method (October 2005 - March 2008). Effective April 1,
2008, the annuity regardless of age will be 55 percent of the level of coverage selected. The annuity paid to a child or children totals 55 percent (divided in equal shares).
Children annuities are payable to children who are: under age 18; or under age 22 if full time, unmarried students; or any age if disabled and incapable of self-support
before 18 (or 22, if while a full time student). An insurable interest annuity is 55 percent of the difference between retired pay and the premium for coverage. Insurable
interest annuities remain at 55 percent of the net base amount regardless of age. Place an X in the appropriate box to indicate your election.
FULL RETIRED PAY.
$
REDUCED AMOUNT OF RETIRED PAY (Cannot be less than $300.00)
SECTION VI - SPOUSE AND CHILD(REN) INFORMATION (If applicable)
12a. SPOUSE'S NAME (Last, First, Middle Initial)
12b. SSN
12c. DATE OF BIRTH
12d. DATE OF MARRIAGE
(YYYYMMDD)
(YYYYMMDD)
13. DEPENDENT CHILDREN. Complete this section for your unmarried, dependent children who are under age 18; or under age 22 if full time students; or any age if
disabled and incapable of self-support before age 18 (or 22 if a full time student).
a.
b.
c
d.
e.
CHILD'S NAME
SOCIAL SECURITY
DATE OF BIRTH
RELATIONSHIP
DISABLED?
(Last, First, Middle Initial)
NUMBER
(YYYYMMDD)
(Natural, Step, Adopted, Foster)
(YES/NO)
(1)
(2)
(3)
(4)
(5)
(6)
SECTION VII - MEMBER SIGNATURE
A NOTARY PUBLIC OR SBP COUNSELOR MUST WITNESS THE MEMBER'S SIGNATURE. The witness cannot be the member's spouse, or beneficiary.
14. SIGNATURE OF MEMBER
15. DATE SIGNED (YYYYMMDD)
16b. SIGNATURE OF WITNESS
16a. PRINTED NAME OF WITNESS (Last, First, Middle Initial)
16c. DATE SIGNED (YYYYMMDD)
16d. MAILING ADDRESS OF WITNESS (Include ZIP Code)
16e. (For Notary Use Only) MY COMMISSION EXPIRES (YYYYMMDD)
SECTION VIII - SPOUSE SIGNATURE
A NOTARY PUBLIC OR SBP COUNSELOR MUST WITNESS THE SPOUSE SIGNATURE. The witness cannot be the his/her spouse, or beneficiary.
17. SIGNATURE OF SPOUSE
18. DATE SIGNED (YYYYMMDD)
19a. PRINTED NAME OF WITNESS (Last, First, Middle Initial)
19b. SIGNATURE OF WITNESS
19c. DATE SIGNED (YYYYMMDD)
19d. MAILING ADDRESS OF WITNESS (Include ZIP Code)
19e. (For Notary Use Only) MY COMMISSION EXPIRES (YYYYMMDD)
Page 2 of 2
DD FORM 2656-6, JULY 2020
PREVIOUS EDITION IS OBSOLETE.
Page of 2