DD Form 2656-1 "Survivor Benefit Plan (SBP) / Reserve Component (RC) Election Statement for Former Spouse Coverage"

What Is DD Form 2656-1?

DD Form 2656-1, SBP Election Statement for Former Spouse Coverage is a form used to convert an existing SBP spouse coverage election into former spouse coverage for eligible spouses of service members within the United States Military.

The latest available edition of the DD 2656-1 was issued by the Department of Defense (DoD) on July 1, 2020. An up-to-date fillable version of the form is available for download or digital filing below.

The retiree and former spouse must complete the form indicating whether the election is being made pursuant to a court order, a written agreement, or voluntarily. The DD Form 2656-1 is a part of a package of forms related to establishing retainer or retired pay accounts, electing Survivor Benefit Program (SBP) coverage or terminating SBP participation.

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DD Form 2656-1 Instructions

The DD Form 2656-1 must be submitted within one year of the court order requiring coverage in order to convert the coverage from spouse to former spouse. Unless this is done, the former spouse will not be covered.

Retired members must complete Sections I, II and III. Retiring members file Sections II and III only, making the election on the DD Form 2656, Data for Payment of Retired Personnel. All service members and former spouses must complete Section III when filing the form.

  1. Section I, Election of Coverage is filed only by retired members. Place an X in the appropriate block to indicate if the election is for a former spouse with children or for a former spouse alone.
  2. Section II, Retired and Retired Members consists of Items 2 through 11. Indicate your marital status in Item 2. Choose the legal reasons for coverage out of Items 3, 4 or 5. Items 6 and 7 are self-explanatory and describe the date of birth of the former spouse and the date of your marriage to them. Enter the date of divorce decree in Item 8.

    Item 9 is filed if the former spouse has remarried. If former spouse remarries before the age of 55, the coverage will be suspended and premiums will not be deducted from members retired pay for the duration of that marriage. Coverage will resume if the marriage ends by divorce, death or annulment.

    Item 10 is for listing eligible children from the former marriage. Indicate in a child is incapable of supporting themselves in Block 10e and attach proof if any is available.

    Item 11 may be used for comments or any additional information.

  3. Section III is for certification and is filed and signed by the retiree, former spouse and their two witnesses.

DD 2656-1 Related Forms

The DD 2656-1 has eight related SBP-themed forms, each with its distinctive features and a specific purpose.

  1. DD Form 2656, Data for Payment of Retired Personnel provides data needed to establish a retainer or retired pay account, designate beneficiaries for unpaid retired pay or establishing a SBP election.
  2. DD Form 2656-2, SBP Termination Request is used to voluntarily discontinue participation in the SBP and is valid only if the spouse's or former spouse's concurrence is witnessed by a Notary public or a designated SBP Counsellor.
  3. DD Form 2656-5, RCSBP Election Certificate is used by Reserve Component Members to make an election for the Reserve Component SBP after receiving notification of being eligible to claim their Reserve retired pay.
  4. DD Form 2656-6, SBP Election Change Certificate is used to change a SBP election by retired members of the military.
  5. DD Form 2656-7, Verification for Survivor Annuity is used by the surviving or former spouse and dependent children to verify eligibility for an annuity under the Retired Servicemen's Family Protection Plan, Reserve Component SBP or the SBP.
  6. DD Form 2656-8, SBP Automatic Coverage Fact Sheet is used to record the marital and dependency status of the service member to establish and maintain an accurate accounting of the RPA (retired pay account).
  7. DD Form 2656-10, SBP/RC SBP Request for Deemed Election is used by former spouses to provide information related to SBP coverage to a Uniformed Service designated agent.
  8. DD Form 2656-11, Statement Certifying Number of Months of SBP Premiums Paid is filed if the individual disagrees with the number of months credited toward paid-up SBP by the Defense Finance and Accounting Service (DFAS).
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Download DD Form 2656-1 "Survivor Benefit Plan (SBP) / Reserve Component (RC) Election Statement for Former Spouse Coverage"

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SURVIVOR BENEFIT PLAN (SBP) / RESERVE COMPONENT (RC) ELECTION STATEMENT FOR FORMER
OMB No. 0704 - 0569
SPOUSE COVERAGE
OMB approval expires
20230731
(Please read Privacy Act statement and instructions on back BEFORE completing this form.)
SECTION I - ELECTION OF COVERAGE - RETIRED MEMBERS ONLY
RETIRED MEMBER
RETIRING MEMBER
- RETIRED/GREY AREA RETIRED members changing from spouse or spouse and child(ren) coverage to former spouse or former spouse and child(ren) coverage.
- To elect coverage for former spouse or former spouse and child(ren), Retiring members must complete required section of DD Form 2656 and RC Members making initial
RCSBP election must complete required section of the DD Form 2656-5.
*NOTE: If an election included child(ren), list in Item 10 ONLY the child(ren) resulting from
1. DUE TO DIVORCE, CHANGE MY SBP OR RC-SBP COVERAGE TO: (X one)
the marriage of the member and the former spouse. Include the date of birth and SSN for
FORMER SPOUSE
FORMER SPOUSE AND CHILD(REN)*
each child.
SECTION II - RETIRED MEMBERS IN RECEIPT OF RETIRED PAY, GREY AREA RETIRED MEMBERS, AND RC MEMBERS MAKING
YES
NO
INITIAL RCSBP ELECTION
2. ARE YOU CURRENTLY MARRIED?
3. IS THIS ELECTION BEING MADE COLUNTARILY AND NOT PURSUANT TO A COURT ORDER?
4. IS THIS ELECTION BEING MADE PURSUANT TO THE REQUIREMENTS OF A COURT ORDER?
5. IS THIS ELECTION BEING MADE PURSUANT TO A WRITTEN AGREEMENT PREVIOUSLY ENTERED INTO VOLUNTARILY AS
PART OF OR INCIDENT TO A PROCEEDING OF DIVORCE, DISSOLUTION OR ANNULMENT?
6. IF "YES" TO ITEM 4, WAS SUCH A VOLUNTARY WRITTEN AGREEMENT INCORPORATED IN, RATIFIED, OR APPROVED BY A COURT ORDER?
10. HAS FORMER SPOUSE REMARRIED?
7. DATE OF BIRTH OF FORMER
8. DATE MARRIED TO FORMER
9. DATE DIVORCED FROM FORMER
(If "YES", give date - YYYYMMDD)
SPOUSE (YYYYMMDD)
SPOUSE (YYYYMMDD)
SPOUSE (YYYYMMDD)
YES
NO
11. DEPENDENT CHILDREN (in Item 11 list ONLY the child(ren) resulting in from the marriage of the member and the former spouse. Include the date of birth and SSN for each child.)
a. NAME
b. DATE OF BIRTH
d. RELATIONSHIP
e. DISABLED?
c. SSN
(Last, First, Middle Initial)
(YYYYMMDD)
(Son, daughter, etc.)
(Yes/No)
12. REMARKS
SECTION III - CERTIFICATIONS - RETIRED MEMBERS IN RECEIPT OF RETIRED PAY, GREY AREA RETIRED MEMBERS, RC MEMBERS MAKING
INITIAL RCSBP ELECTION, AND FORMER SPOUSES
13. MEMBER
14. FORMER SPOUSE TO BE COVERED
a. NAME (Last, First, Middle Initial
b. SSN or DoDID
a. NAME (Last, First, Middle Initial
b. SSN or DoDID
c. SIGNATURE
c. SIGNATURE
d. ADDRESS
d. ADDRESS
(1) STREET (Include apartment number)
(1) STREET (Include apartment number)
(2) CITY
(3) STATE
(4) ZIP CODE
(2) CITY
(3) STATE
(4) ZIP CODE
Alabama
Alabama
(5) PHONE NUMBER
(6) EMAIL ADDRESS
(5) PHONE NUMBER
(6) EMAIL ADDRESS
Page 1 of 2
DD FORM 2656-1, JULY 2020
PREVIOUS EDITION IS OBSOLETE.
SURVIVOR BENEFIT PLAN (SBP) / RESERVE COMPONENT (RC) ELECTION STATEMENT FOR FORMER
OMB No. 0704 - 0569
SPOUSE COVERAGE
OMB approval expires
20230731
(Please read Privacy Act statement and instructions on back BEFORE completing this form.)
SECTION I - ELECTION OF COVERAGE - RETIRED MEMBERS ONLY
RETIRED MEMBER
RETIRING MEMBER
- RETIRED/GREY AREA RETIRED members changing from spouse or spouse and child(ren) coverage to former spouse or former spouse and child(ren) coverage.
- To elect coverage for former spouse or former spouse and child(ren), Retiring members must complete required section of DD Form 2656 and RC Members making initial
RCSBP election must complete required section of the DD Form 2656-5.
*NOTE: If an election included child(ren), list in Item 10 ONLY the child(ren) resulting from
1. DUE TO DIVORCE, CHANGE MY SBP OR RC-SBP COVERAGE TO: (X one)
the marriage of the member and the former spouse. Include the date of birth and SSN for
FORMER SPOUSE
FORMER SPOUSE AND CHILD(REN)*
each child.
SECTION II - RETIRED MEMBERS IN RECEIPT OF RETIRED PAY, GREY AREA RETIRED MEMBERS, AND RC MEMBERS MAKING
YES
NO
INITIAL RCSBP ELECTION
2. ARE YOU CURRENTLY MARRIED?
3. IS THIS ELECTION BEING MADE COLUNTARILY AND NOT PURSUANT TO A COURT ORDER?
4. IS THIS ELECTION BEING MADE PURSUANT TO THE REQUIREMENTS OF A COURT ORDER?
5. IS THIS ELECTION BEING MADE PURSUANT TO A WRITTEN AGREEMENT PREVIOUSLY ENTERED INTO VOLUNTARILY AS
PART OF OR INCIDENT TO A PROCEEDING OF DIVORCE, DISSOLUTION OR ANNULMENT?
6. IF "YES" TO ITEM 4, WAS SUCH A VOLUNTARY WRITTEN AGREEMENT INCORPORATED IN, RATIFIED, OR APPROVED BY A COURT ORDER?
10. HAS FORMER SPOUSE REMARRIED?
7. DATE OF BIRTH OF FORMER
8. DATE MARRIED TO FORMER
9. DATE DIVORCED FROM FORMER
(If "YES", give date - YYYYMMDD)
SPOUSE (YYYYMMDD)
SPOUSE (YYYYMMDD)
SPOUSE (YYYYMMDD)
YES
NO
11. DEPENDENT CHILDREN (in Item 11 list ONLY the child(ren) resulting in from the marriage of the member and the former spouse. Include the date of birth and SSN for each child.)
a. NAME
b. DATE OF BIRTH
d. RELATIONSHIP
e. DISABLED?
c. SSN
(Last, First, Middle Initial)
(YYYYMMDD)
(Son, daughter, etc.)
(Yes/No)
12. REMARKS
SECTION III - CERTIFICATIONS - RETIRED MEMBERS IN RECEIPT OF RETIRED PAY, GREY AREA RETIRED MEMBERS, RC MEMBERS MAKING
INITIAL RCSBP ELECTION, AND FORMER SPOUSES
13. MEMBER
14. FORMER SPOUSE TO BE COVERED
a. NAME (Last, First, Middle Initial
b. SSN or DoDID
a. NAME (Last, First, Middle Initial
b. SSN or DoDID
c. SIGNATURE
c. SIGNATURE
d. ADDRESS
d. ADDRESS
(1) STREET (Include apartment number)
(1) STREET (Include apartment number)
(2) CITY
(3) STATE
(4) ZIP CODE
(2) CITY
(3) STATE
(4) ZIP CODE
Alabama
Alabama
(5) PHONE NUMBER
(6) EMAIL ADDRESS
(5) PHONE NUMBER
(6) EMAIL ADDRESS
Page 1 of 2
DD FORM 2656-1, JULY 2020
PREVIOUS EDITION IS OBSOLETE.
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. Chapter 73, subchapter II Survivor Benefit Plan; DoD Instruction 1332-42, Survivor Annuity Program Administration; DoD Financial Management Regulation,
Volume 7B; and E.O. 9397 (SSN), as amended.
PRINCIPAL PURPOSE(S): To establish a Survivor Benefit Plan election for the eligible former spouse of a service member..
ROUTINE USE(S): To former spouses for purposes of providing information, consistent with the requirements of 10 U.S.Code, Section 1450(f)(3), regarding Survivor Benefit Plan
coverage. To spouses for purposes of providing information, consistent with the requirements of 10 U.S.Code, Section 1448(a), regarding Survivor Benefit Plan 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 furnish requested information may result in delay in initiating Survivor Benefit Plan coverage for a former spouse.
GENERAL.
ITEM 10. Mark the appropriate block. If "Yes," provide the date that
member's former spouse remarried. Former spouse may remarry
Type or print all information in ink.
after age 55 and eligibility will not be affected. If former spouse
remarries before age 55, coverage is suspended and premiums are
RETIRED MEMBERS: Complete Sections I, II, and III. If electing
not deducted from member's retired pay for the duration of that
former spouse and child(ren) coverage, provide information pertaining
marriage. If former spouse's marriage ends by death, divorce, or
to eligible child(ren) in Item 10, "Dependent Children."
annulment, coverage will resume. Retiree or former spouse must
notify DFAS of any changes in former spouse's marital status,
RETIRING MEMBERS: Complete Sections II and III, but make the
providing appropriate documentation
election on DD Form 2656, "Data for Payment of Retired Personnel."
ITEM 11. Retired members electing former spouse and child(ren)
ALL MEMBERS AND FORMER SPOUSES must complete Section III.
must list eligible children in this section. Only children resulting from
the marriage of the member and the former spouse are covered in a
When the form has been completed (ensure it is signed by both
former spouse and child(ren) election. The former spouse is the
member and former spouse, and is properly witnessed), submit it to:
primary beneficiary; children receive an annuity only if the former
spouse remarries before age 55 or dies. Indicate in block 11.e. if the
Defense Finance and Accounting Service
child is incapable of self support and attach substantiating
U.S. Military Retired Pay
documentation, if available. Eligible children of retiring members
8899 E. 56th Street
should be listed in Block 25 of DD Form 2656.
Indianapolis, IN 46249-1200
ITEM 12. This block may be used for comments or additional
Attach a certified copy of the divorce decree, amendment, or other
information not covered in the form.
documentation as described in Items 3, 4, and 5. If not received by
DFAS within the first year following the date of divorce, the election will
SECTION III.
be invalid.
ITEMS 13 through 14. Self-explanatory.
SECTION I.
ITEM 1. Retired member places an X in the appropriate block to
indicate whether election is for former spouse, or former spouse with
child(ren) coverage.
SECTION II.
ITEM 2. Indicate member's marital status by marking appropriate block.
ITEMS 3, 4, and 5. Mark the block that reflects legal basis for
coverage.
ITEMS 6 and 7. Self-explanatory.
ITEM 9. Enter date of divorce decree, or amendment requiring SBP..
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.
DD FORM 2656-1, JULY 2020
Page 2 of 2
PREVIOUS EDITION IS OBSOLETE.
Page of 2