DD Form 2656-10 Survivor Benefit Plan (SBP)/Reserve Component (RC) SBP 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) in April 2009 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 a 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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OMB No. 0704-0448
SURVIVOR BENEFIT PLAN (SBP)/RESERVE COMPONENT (RC)
OMB approval expires
SBP REQUEST FOR DEEMED ELECTION
Apr 30, 2011
The public reporting burden for this collection of information is estimated to average 20 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, Executive Services Directorate, Directives Division, Information Management
Branch, 1155 Defense Pentagon, Washington, DC 20301-1155 (0704-0448). 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; DoD Instruction 1332.42, Survivor Annuity Program Administration; DoD Financial
Management Regulation, Volume 7B, Chapter 43; and E.O. 9397 (SSN).
PRINCIPAL PURPOSE(S): Used by a former spouse to deem an election for Former Spouse SBP coverage.
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 Survivor Benefit Plan coverage.
DISCLOSURE: Voluntary; however, failure to provide requested information within the first year following filing of the court order or filing which
requires former spouse SBP coverage will result in delays in initiating, or denial of, former spouse SBP coverage.
INSTRUCTIONS
GENERAL.
1. Read these instructions carefully before completing the form. Please print legibly.
2. Ensure that you advise the finance center (see Item 3 below for address) of your marital status, correspondence and check address changes, at
all times. Reserve Component former spouses must notify their personnel center (see Item 4 below for address) of their marital status and
correspondence address at all times.
3. For those who are deeming an SBP election against a member who is currently serving on active duty or receiving retired pay, mail your election
(certified or registered mail with return receipt requested is strongly recommended) to the appropriate Uniformed Service designated agent. The
Uniformed Services' designated agents are:
(a) ARMY, NAVY, AIR FORCE and MARINE CORPS: Defense Finance and Accounting Service, Garnishment Operations, Post Office Box
998002, Cleveland OH 44199-8002
(b) COAST GUARD: Commanding Officer (LGL), USCG Personnel Service Center, 444 S.E. Quincy Street, Topeka, KS 66683-3591;
(c) PUBLIC HEALTH SERVICE: Office of Commissioned Corps Support Services, Compensation Branch, 5600 Fishers Lane, Room 4-50,
Rockville, MD 20857;
(d) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION: Same as U.S. Coast Guard.
4. For those who are deeming an SBP election against a Reserve Component member who is not yet receiving retired pay (under age 60), mail your
election (certified or registered mail with return receipt attached is strongly recommended) to the appropriate Branch of Service as follows:
(a) ARMY: Commander, Human Resources Command - St. Louis, ATTN: AHRC-PAP-T, 1 Reserve Way, St. Louis, MO 63132-5200;
(b) NAVY: Navy Reserve Personnel Center (PERS 912), 5722 Integrity Drive, Millington, TN 38054;
(c) AIR FORCE: Headquarters, ARPC/DPSSE, 6760 E. Irvington Place, Denver, CO 80250-4020;
(d) MARINE CORPS: Headquarters, U.S. Marine Corps, Separation & Retirement Branch (MMSR-6), 3280 Russell Road, Quantico, VA
22134-5103;
(e) COAST GUARD: Commanding Officer (LGL), USCG Personnel Service Center, 444 S.E. Quincy Street, Topeka, KS 66683-3591.
SECTION I - MEMBER IDENTIFICATION
1. MEMBER NAME
2. SSN
3.a. BRANCH OF SERVICE
(Last, First, Middle Initial)
b. (X one)
ACTIVE
RESERVE
NATIONAL GUARD
5. IF YES, DATE OF RETIREMENT
(YYYYMMDD)
4. IS MEMBER RETIRED?
YES
NO
SECTION II - FORMER SPOUSE IDENTIFICATION
6. FORMER SPOUSE NAME
7. SSN
8. ADDRESS
9. DATE OF BIRTH
(Last, First,
(Include ZIP Code)
Middle Initial)
(YYYYMMDD)
10. MARRIAGE HISTORY
c. ARE YOU CURRENTLY MARRIED?
a. DATE MARRIED TO MEMBER
b. DATE OF DIVORCE
d. IF YES, DATE OF CURRENT
(Listed in Item 1 above) (YYYYMMDD)
(YYYYMMDD)
MARRIAGE (YYYYMMDD)
YES
NO
DD FORM 2656-10, APR 2009
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional 8.0
OMB No. 0704-0448
SURVIVOR BENEFIT PLAN (SBP)/RESERVE COMPONENT (RC)
OMB approval expires
SBP REQUEST FOR DEEMED ELECTION
Apr 30, 2011
The public reporting burden for this collection of information is estimated to average 20 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, Executive Services Directorate, Directives Division, Information Management
Branch, 1155 Defense Pentagon, Washington, DC 20301-1155 (0704-0448). 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; DoD Instruction 1332.42, Survivor Annuity Program Administration; DoD Financial
Management Regulation, Volume 7B, Chapter 43; and E.O. 9397 (SSN).
PRINCIPAL PURPOSE(S): Used by a former spouse to deem an election for Former Spouse SBP coverage.
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 Survivor Benefit Plan coverage.
DISCLOSURE: Voluntary; however, failure to provide requested information within the first year following filing of the court order or filing which
requires former spouse SBP coverage will result in delays in initiating, or denial of, former spouse SBP coverage.
INSTRUCTIONS
GENERAL.
1. Read these instructions carefully before completing the form. Please print legibly.
2. Ensure that you advise the finance center (see Item 3 below for address) of your marital status, correspondence and check address changes, at
all times. Reserve Component former spouses must notify their personnel center (see Item 4 below for address) of their marital status and
correspondence address at all times.
3. For those who are deeming an SBP election against a member who is currently serving on active duty or receiving retired pay, mail your election
(certified or registered mail with return receipt requested is strongly recommended) to the appropriate Uniformed Service designated agent. The
Uniformed Services' designated agents are:
(a) ARMY, NAVY, AIR FORCE and MARINE CORPS: Defense Finance and Accounting Service, Garnishment Operations, Post Office Box
998002, Cleveland OH 44199-8002
(b) COAST GUARD: Commanding Officer (LGL), USCG Personnel Service Center, 444 S.E. Quincy Street, Topeka, KS 66683-3591;
(c) PUBLIC HEALTH SERVICE: Office of Commissioned Corps Support Services, Compensation Branch, 5600 Fishers Lane, Room 4-50,
Rockville, MD 20857;
(d) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION: Same as U.S. Coast Guard.
4. For those who are deeming an SBP election against a Reserve Component member who is not yet receiving retired pay (under age 60), mail your
election (certified or registered mail with return receipt attached is strongly recommended) to the appropriate Branch of Service as follows:
(a) ARMY: Commander, Human Resources Command - St. Louis, ATTN: AHRC-PAP-T, 1 Reserve Way, St. Louis, MO 63132-5200;
(b) NAVY: Navy Reserve Personnel Center (PERS 912), 5722 Integrity Drive, Millington, TN 38054;
(c) AIR FORCE: Headquarters, ARPC/DPSSE, 6760 E. Irvington Place, Denver, CO 80250-4020;
(d) MARINE CORPS: Headquarters, U.S. Marine Corps, Separation & Retirement Branch (MMSR-6), 3280 Russell Road, Quantico, VA
22134-5103;
(e) COAST GUARD: Commanding Officer (LGL), USCG Personnel Service Center, 444 S.E. Quincy Street, Topeka, KS 66683-3591.
SECTION I - MEMBER IDENTIFICATION
1. MEMBER NAME
2. SSN
3.a. BRANCH OF SERVICE
(Last, First, Middle Initial)
b. (X one)
ACTIVE
RESERVE
NATIONAL GUARD
5. IF YES, DATE OF RETIREMENT
(YYYYMMDD)
4. IS MEMBER RETIRED?
YES
NO
SECTION II - FORMER SPOUSE IDENTIFICATION
6. FORMER SPOUSE NAME
7. SSN
8. ADDRESS
9. DATE OF BIRTH
(Last, First,
(Include ZIP Code)
Middle Initial)
(YYYYMMDD)
10. MARRIAGE HISTORY
c. ARE YOU CURRENTLY MARRIED?
a. DATE MARRIED TO MEMBER
b. DATE OF DIVORCE
d. IF YES, DATE OF CURRENT
(Listed in Item 1 above) (YYYYMMDD)
(YYYYMMDD)
MARRIAGE (YYYYMMDD)
YES
NO
DD FORM 2656-10, APR 2009
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional 8.0
MEMBER NAME
SSN
(Last, First, Middle Initial)
SECTION III - AUTHORITY TO REQUEST DEEMED SBP ELECTION
11. IS ELECTION MADE PURSUANT TO REQUIREMENTS OF COURT ORDER?
(If "Yes, attach a copy of the document.)
YES
NO
12. IS ELECTION BEING MADE PURSUANT TO WRITTEN AGREEMENT PREVIOUSLY ENTERED INTO
YES
NO
VOLUNTARILY AS PART OF OR INCIDENT TO A PROCEEDING OF DIVORCE, DISSOLUTION OR ANNULMENT?
NOTE: If you answered "No" to both 11 and 12, above, STOP. You are NOT eligible to request a Deemed SBP election.
13. IF "YES" TO QUESTION 12, WAS SUCH VOLUNTARY WRITTEN AGREEMENT INCORPORATED IN,
YES
NO
RATIFIED, OR APPROVED BY A COURT ORDER?
(If "Yes, attach a copy of the document.)
SECTION IV - DEPENDENT CHILDREN INFORMATION
14. LIST DEPENDENT CHILDREN
(If required to be covered under court order/agreement) (List only children resulting from the parties' marriage to each other.)
b. DATE OF BIRTH
d. RELATIONSHIP
e. DISABLED?
a. NAME (Last, First, Middle Initial)
c. SSN
(YYYYMMDD)
(Son, daughter, stepson, etc.)
(Yes/No)
15. REMARKS
(Use this space to further explain any item if necessary. Reference by item number.)
SECTION V - FORMER SPOUSE SIGNATURE
16. SIGNATURE
17. DATE SIGNED
(YYYYMMDD)
DD FORM 2656-10 (BACK), APR 2009
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Download DD Form 2656-10 Survivor Benefit Plan (SBP)/Reserve Component (RC) SBP Request for Deemed Election

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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 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 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.

DD 2656-10 Related Forms

  1. DD Form 2656, Data for Payment of Retired Personnel is used to elect an SBP and designate beneficiaries for retired pay.
  2. DD Form 2656-1, SBP Election Statement for Former Spouse Coverage is a form used by spouses and former spouses of servicemen for purposes of providing information regarding SBP benefits.
  3. DD Form 2656-2 is the SBP Termination Request. The form is used to voluntarily discontinue participation in the Uniformed Services Survivor Benefit Plan and is witnessed by a Notary public or a designated SBP Counsellor.
  4. DD Form 2656-5 or the RCSBP Election Certificate is used by Reserve Component Members to make an election for the Reserve Component Survivor Benefit Plan during the 90-day period after receiving notification of eligibility to claim Reserve retired pay.
  5. DD Form 2656-6, SBP Election Change Certificate is a form submitted to the Defense Finance and Accounting Service in Kentucky or the U.S. Public Health Service/Commissioned Corps in Maryland to change a Survivor Benefit Plan election.
  6. DD Form 2656-7, Verification for Survivor Annuity is used by the surviving spouse, former spouse or dependent children to verify eligibility for an annuity under the Survivor Benefit Plan, Retired Servicemen's Family Protection Plan or Reserve Component Survivor Benefit Plan.
  7. DD Form 2656-8 - the SBP Automatic Coverage Fact Sheet - is a form that does not play part in electing SBP. The DD 2656-8 is used to update service members' marital and dependency data to accurately maintain their retired pay account.
  8. DD Form 2656-11, Statement Certifying Number of Months of SBP Premiums Paid is a form sent to DFAS at London, Kentucky to contest the number of months credited toward Paid-up SBP by the Defense Finance and Accounting Service.

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