SF1174
Claim for Unpaid Compensation of Deceased Member of the Uniformed Services
Standard Form 1174 (SF 1174), Claim for Unpaid Compensation of Deceased Member of the Uniformed Services, is a two-page claim for compensation owed to a member of the uniformed services who has died. The footer prints Standard Form 1174 (EG), September 1992, 4 GAO 26.1, and says the form has been authorized for local reproduction. GSA hosts a copy in its forms library.
The form says any assistance deemed necessary for the proper execution of this form will be furnished to all claimants by the employing agency, and to forward the completed form to the Government agency in which the deceased was employed at time of death. Parts A to E cover the claimants and the decedent, the widow's certification of the marriage, surviving relatives, an executor or administrator, and funeral expenses. Two witnesses sign that the claimant's signature was affixed in their presence.
Each page also prints Updated 20260213 at the top. You can fill it out free in your browser on this page and download the result without an account.
Claimant names and Social Security numbers, relationship, age if a minor, beneficiary questions, state of legal residence, the decedent's name, rank or rating, service number and SSN, date of death, name of service and domicile.
A question for the widow only: whether she or he was married to the decedent and, to the best of their knowledge, the marriage was not dissolved before the death.
Name and Social Security number, age, relationship to the deceased and address of each person in the order the form lists.
A statement of appointment as executor or administrator of the estate with the certificate of appointment, or, if none has been appointed, whether one will be.
Whether the funeral expenses have been paid, with the receipted bill of the undertaker attached if so, and whose money was used to pay them.
Signature, date and address lines for two claimants, followed by the certification, signatures and addresses of two witnesses.
Enter the claimant and decedent details in items 1 to 10, including the date of death and the name of service.
The form says Part B is for the widow only, widows, widowers and designated beneficiaries do not fill in Part C, and designated beneficiaries, surviving spouses, children, parents or legal representatives do not fill in Part E.
A court certificate for an executor or administrator, the undertaker's receipted bill if funeral expenses were paid, and all Federal checks in the claimant's possession drawn to the order of the decedent for pay and allowance.
Each claimant signs and dates and gives an address. Two witnesses sign that the claimant's signature was affixed in their presence.
The form says to forward the completed form to the Government agency in which the deceased was employed at time of death.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The form says to forward the completed form to the Government agency in which the deceased was employed at time of death. It prints no address or deadline.
The form says any assistance deemed necessary for the proper execution of the form will be furnished to all claimants by the employing agency.
The form says all Federal checks in possession of the claimant, drawn to the order of the decedent, in payment of pay and allowance should accompany the claim.
The form warns that fines and penalties are imposed by law for false or fraudulent claims against the United States or for false statements made in connection with them.
The footer prints Standard Form 1174 (EG), September 1992, 4 GAO 26.1. GSA's page lists 4 GAO 26.1 as the authority or regulation and 09/1992 as the current revision date.
SF1153
73 fields, 2 pages
SF1154
79 fields, 2 pages
SF1152
33 fields, 4 pages
SF180
72 fields, 3 pages
The form says which claimants complete which parts.
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The footer prints Standard Form 1174 (EG), September 1992, 4 GAO 26.1. GSA hosts a copy in its forms library.
The form says to forward the completed form to the Government agency in which the deceased was employed at time of death, and that the employing agency will furnish any assistance deemed necessary.
Part A asks for the claimant and decedent details. The form says Part B is for the widow only, widows, widowers and designated beneficiaries do not fill in Part C, and designated beneficiaries, surviving spouses, children, parents or legal representatives do not fill in Part E.
The form says two witnesses are required. For a claim made as the executor or administrator of the estate, it says no witnesses are required, but a court certificate evidencing the appointment is to be submitted.
All Federal checks in the claimant's possession drawn to the order of the decedent for pay and allowance, the undertaker's receipted bill if funeral expenses were paid, and a court certificate for an executor or administrator.
Yes. Part A item 1 takes the names and Social Security numbers of claimants, and the back has signature, date and address lines for two claimants.
