DD Form 2656-6 Survivor Benefit Plan Election Change 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) in April 2009. 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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SURVIVOR BENEFIT PLAN ELECTION CHANGE CERTIFICATE
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 uniformed service retirees to change their Survivor Benefit Plan election upon certain events occurring.
ROUTINE USE(S): None.
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
This form is used to change a Survivor Benefit Plan election. A retired member may change an election under certain circumstances when
specific conditions are met. Section III of this form describes these conditions and instructs you what additional sections of the form to complete.
Complete this form and submit to the appropriate agency listed below with appropriate documentation, such as marriage certificates, birth
certificates, divorce decree, etc., as required. Contact your Service Representative if you have questions or need assistance completing this form.
For Army, Navy, Air Force and Marine Corps accounts, send the completed form to: Defense Finance and Accounting Service, U.S. Military
Retired Pay, 8899 E. 56th Street, Indianapolis, IN 46249-1200. For Public Health Service accounts, send the completed form to: U.S. Public
Health Service/Commissioned Corps, 5600 Fishers Lane, Room 4-50, Rockville, MD 20857-0001.
NOTE: Do NOT use this form to elect to terminate SBP coverage under the provisions of Title 10 U.S.C., Section 1448a. Use DD Form 2656-2,
"SBP Termination Request".
Do NOT use this form to elect coverage for a former spouse. Use DD Form 2656-1, "Former Spouse Election Certificate".
SECTION I - MEMBER INFORMATION
3. DATE OF RETIREMENT
4. DATE OF BIRTH
1. NAME (Last, First, Middle Initial)
2. SOCIAL SECURITY NUMBER
(YYYYMMDD)
(YYYYMMDD)
5. MAILING ADDRESS (Street, Apartment Number, City, State, and ZIP Code)
6. TELEPHONE NUMBER
(Include area code)
SECTION II - CURRENT COVERAGE
7. MY CURRENT COVERAGE IS: (X one)
NO COVERAGE
SPOUSE ONLY
CHILD ONLY
SPOUSE AND CHILD
FORMER SPOUSE AND
SUSPENDED COVERAGE
INSURABLE INTEREST
FORMER SPOUSE
CHILD
(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.
SECTION III - CONDITIONS THAT TRIGGER ELIGIBILITY TO CHANGE COVERAGE
8. 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).
The following additional option is available for members who have former spouse coverage, who remarry and the member is allowed to
discontinue that coverage:
(4) Select coverage for my new spouse if my current coverage is former spouse coverage (Complete 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.
DD FORM 2656-6, APR 2009
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional 8.0
SURVIVOR BENEFIT PLAN ELECTION CHANGE CERTIFICATE
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 uniformed service retirees to change their Survivor Benefit Plan election upon certain events occurring.
ROUTINE USE(S): None.
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
This form is used to change a Survivor Benefit Plan election. A retired member may change an election under certain circumstances when
specific conditions are met. Section III of this form describes these conditions and instructs you what additional sections of the form to complete.
Complete this form and submit to the appropriate agency listed below with appropriate documentation, such as marriage certificates, birth
certificates, divorce decree, etc., as required. Contact your Service Representative if you have questions or need assistance completing this form.
For Army, Navy, Air Force and Marine Corps accounts, send the completed form to: Defense Finance and Accounting Service, U.S. Military
Retired Pay, 8899 E. 56th Street, Indianapolis, IN 46249-1200. For Public Health Service accounts, send the completed form to: U.S. Public
Health Service/Commissioned Corps, 5600 Fishers Lane, Room 4-50, Rockville, MD 20857-0001.
NOTE: Do NOT use this form to elect to terminate SBP coverage under the provisions of Title 10 U.S.C., Section 1448a. Use DD Form 2656-2,
"SBP Termination Request".
Do NOT use this form to elect coverage for a former spouse. Use DD Form 2656-1, "Former Spouse Election Certificate".
SECTION I - MEMBER INFORMATION
3. DATE OF RETIREMENT
4. DATE OF BIRTH
1. NAME (Last, First, Middle Initial)
2. SOCIAL SECURITY NUMBER
(YYYYMMDD)
(YYYYMMDD)
5. MAILING ADDRESS (Street, Apartment Number, City, State, and ZIP Code)
6. TELEPHONE NUMBER
(Include area code)
SECTION II - CURRENT COVERAGE
7. MY CURRENT COVERAGE IS: (X one)
NO COVERAGE
SPOUSE ONLY
CHILD ONLY
SPOUSE AND CHILD
FORMER SPOUSE AND
SUSPENDED COVERAGE
INSURABLE INTEREST
FORMER SPOUSE
CHILD
(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.
SECTION III - CONDITIONS THAT TRIGGER ELIGIBILITY TO CHANGE COVERAGE
8. 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).
The following additional option is available for members who have former spouse coverage, who remarry and the member is allowed to
discontinue that coverage:
(4) Select coverage for my new spouse if my current coverage is former spouse coverage (Complete 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.
DD FORM 2656-6, APR 2009
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional 8.0
MEMBER NAME (Last, First, Middle Initial)
SSN
SECTION IV - REQUESTED CHANGE TO COVERAGE
9. 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
10. 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)
12. DATE OF MARRIAGE
b. SOCIAL SECURITY
c. DATE OF BIRTH
11. a. SPOUSE'S NAME (Last, First, Middle Initial)
(YYYYMMDD)
NUMBER
(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).
d. RELATIONSHIP
(Son, daughter,
b. SOCIAL SECURITY
c. DATE OF BIRTH
e. DISABLED?
a. CHILD'S NAME
stepson, etc.) (Indicate "FS" if from
(Last, First, Middle Initial)
NUMBER
(Yes/No)
(YYYYMMDD)
previous marriage)
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)
16.a. PRINTED NAME OF WITNESS
b. SIGNATURE
c. DATE SIGNED (YYYYMMDD)
(Last, First, Middle Initial)
d. MAILING ADDRESS OF WITNESS (Include ZIP Code)
e. (For Notary Use Only)
MY COMMISSION EXPIRES: (YYYYMMDD)
DD FORM 2656-6 (BACK), APR 2009
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Download DD Form 2656-6 Survivor Benefit Plan Election Change Certificate

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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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