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DD Form 2656-11 Statement Certifying Number of Months of Survivor Benefit Plan (SBP) Premiums Paid
What Is DD Form 2656-11?
DD Form 2656-11, Statement Certifying Number of Months of Survivor Benefit Plan Premiums Paid is used if the individual disagrees with the number of months credited toward Paid-up Survivor Benefit Plan (SBP) by the Defense Finance and Accounting Service (DFAS).
This form was last revised by the Department of Defense (DoD) on April 1, 2009 , and is part of a series of forms dealing with SBP coverage and termination. An up-to-date fillable version of the DD Form 2656-11 is available for download or digital filing below{class="scroll_to"} or can be found on the Executive Services Directorate website.
The number of months credited toward Paid-up SBP can be found on the retiree's personal Retiree Account Statement (RAS). DD 2656-11 does not require providing any additional documentation. The DFAS will notify retirees when and where to mail all supporting documentation if any will be required.
DD Form 2656-11 Instructions
DD 2656-11 is made up of four sections with most of them being self-explanatory.
Section I, Member Information, requires the full name of the retiree (the last name, first name, and middle initial), social security number, date of birth, home address, and both the telephone number and email address.
Section II, Additional Information, requires the retiree to enter the date of retirement and answer three questions:
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Has any of the following changes happened since the date of retirement:
- A change in marital status (including new marriages or a divorce or annulment of marriage);
- The birth or death of a child;
- The death of a spouse;
- The death of an insurable interest beneficiary to retired pay.
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Has the retiree ever been on the Temporary Disability Retired List (TDRL)?
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Did the retiree have SBP coverage while on the TDRL?
Section III is for certification: retiree must include both the number of months credited and the number of months being claimed.
The last part of DD 2656-11 - Section IV - is for DFAS use only.
The completed form must be sent strictly to the DFAS Headquarters at P.O. Box 7190, Attn: 2656-11, London, KY 40742-7130.
DD 2656-11 Related Forms
- The DD Form 2656 or the Data for Payment of Retired Personnel .
- The DD Form 2656-1 or the SBP Election Statement for Former Spouse Coverage .
- The DD Form 2656-2 or the SBP Termination Request .
- The DD Form 2656-5 or the RCSBP Election Certificate is used by Reserve Component Members .
- The DD Form 2656-6 or the SBP Election Change Certificate .
- The DD Form 2656-7 or the Verification for Survivor Annuity .
- The DD Form 2656-8 or the SBP Automatic Coverage Fact Sheet .
- The DD Form 2656-10 or the SBP/RC SBP Request for Deemed Election .
Download DD Form 2656-11 Statement Certifying Number of Months of Survivor Benefit Plan (SBP) Premiums Paid
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