Section A items 1 to 8: retiree and annuity
Name, date of birth, Social Security number, mailing address, plan or system under which retired, retirement claim number, annuity commencing date, and whether the employee retired on an immediate annuity.
SF2820
Certificate of Insured Employee's Retirement Status
- Agency
- GSA
- Revision
- Revised July 2000
- Fillable fields
- 64
- Pages
- 4
- Official source
- GSA form page
- Checked
- October 20, 2026
Standard Form 2820 (SF 2820): Certification of Insured Employee's Retired Status
Standard Form 2820 (SF 2820), Certification of Insured Employee's Retired Status, is a Federal Employees' Group Life Insurance (FEGLI) Program form. Its footer names the U.S. Office of Personnel Management (OPM) and the FEGLI Handbook, Revised July 2000. GSA hosts a copy in its forms library, where it is listed as Certificate of Insured Employee's Retirement Status.
The instructions say the agency completes Section A for each insured employee who has retired under any system other than the Civil Service Retirement System (CSRS) or the Federal Employees' Retirement System (FERS) and who submits a completed Agency Certification of Insurance Status (SF 2821). OPM completes Section B, certifying whether the person has Basic and Optional insurance as a retired employee. The agency completes Section C when the annuitant dies or the annuity terminates.
The form prints three parts: Part 1 Original, Part 2 Agency Copy and Part 3 File Copy, with instructions on the back of Part 3. You can fill it out free in your browser on this page and download the result without an account.
What's on SF 2820
Section A items 9 to 12: coverage
Whether the employee had Basic for the 5 years immediately before the annuity commencing date, with 75% Reduction, 50% Reduction or No Reduction, Option A, and the Option B and Option C multiples the employee is eligible to carry and wants to carry.
Section A items 13 to 18: agency certification
The certification statement, name and mailing address of agency, signature and typed name of the authorized agency official, date and telephone number.
Section B: OPM certification
Whether the person has Basic insurance as a retired employee or the reason not, the Optional insurance and number of Full Reduction or No Reduction multiples, or reasons B1 to B4, then an OPM official's signature.
Section C: termination of retired status
Reason for termination (death, termination of annuity or other), insurance coverage at the time of termination, next of kin or other contact, date annuity terminated, and the agency official's signature.
Instructions and Definitions
Printed on the back of Part 3: completion and disposition of the form, immediate annuity, reducing or cancelling insurance, post-retirement changes to Basic and Options B and C, the age 65 birthday letter and reporting terminations.
How to complete SF 2820
- 1
Read the back of Part 3
The header says to read the instructions on the back of Part 3 before completing the form.
- 2
Complete Section A
The instructions define an immediate annuity (item 8) as one that begins to accrue no later than 1 month after the date the insurance would otherwise stop, a date shown on the retiree's SF 2821.
- 3
Certify and sign
An authorized agency official completes items 13 to 18 with the agency's name and mailing address, signature, typed name, date and telephone number.
- 4
Send Parts 1 and 2 to OPM
Send them with all life insurance forms (SF 2817, SF 2818, SF 2819, SF 2821, SF 2823, RI 76-10, RI 76-27, FE-8C, etc.) and any court orders to OPM, P.O. Box 45, Boyers, PA 16017-0045. Keep Part 3 in the annuitant's file.
- 5
OPM completes Section B
The instructions say OPM completes Section B and sends the agency a copy for its records, indicating whether the retired annuitant is insured.
- 6
Complete Section C at termination
When the annuitant dies or the annuity terminates, complete Section C and send the form to OPM, with any Claim for Death Benefits (Form FE-6) and certified death certificate the agency received.
Why fill Form SF2820 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the GSA, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes and what the instructions say
Where it goes
Office of Personnel Management (OPM), P.O. Box 45, Boyers, PA 16017-0045. Part 3 stays in the annuitant's file.
Cancelling insurance
An annuitant can cancel Basic and/or Optional insurance at any time unless the coverage was assigned, in which case only the assignees may. Cancelling Basic automatically cancels all Optional insurance. The change is effective at the end of the month the agency receives the written request.
Changing Basic to 75% Reduction
The instructions say Basic can change from No Reduction or 50% Reduction to 75% Reduction at any time unless the coverage was assigned, with no refund of withholdings already made. Changes between No Reduction and 50% Reduction, or from 75% Reduction, are not allowed.
Option B and Option C
The instructions say that, unless the coverage was assigned, all multiples can change between Full Reduction and No Reduction before age 65, and after age 65 only from No Reduction to Full Reduction.
Age 65 birthday letter
The instructions say the agency sends a letter to annuitants shortly before they reach age 65, or shortly after they retire if they retire after 65, giving a choice to mix and match Option B and Option C multiples with No Reduction and Full Reduction.
Related forms
SF2821
Agency Certification of Insurance Status - Federal Employees' Group Life Insurance Program
67 fields, 4 pages
SF2819
Notice of Conversion Privilege - Federal Employees' Life Insurance Program
22 fields, 3 pages
SF2817
Life Insurance Election
37 fields, 5 pages
SF2818
Continuation of Life Insurance Coverage as an Annuitant or Compensationer (FEGLI)
30 fields, 5 pages
SF2823
Designation of Beneficiary - FEGLI
64 fields, 3 pages
Who uses SF 2820?
This is a record kept between the agency and OPM, not a form a retiree files.
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Questions about Form SF2820
Who issues SF 2820?
The footer names the U.S. Office of Personnel Management and the FEGLI Handbook, Revised July 2000. GSA hosts a copy in its forms library.
Which retirees is SF 2820 for?
The instructions say Section A is completed for each insured employee who has retired under any system other than CSRS or FERS and who submits a completed Agency Certification of Insurance Status (SF 2821).
Who completes Section B?
OPM. Section B is the Certification of the Office of Personnel Management, Boyers, PA 16017, signed by an authorized OPM official.
Where is SF 2820 sent?
The instructions say to send Part 1 and Part 2, with all life insurance forms and any applicable court orders, to OPM, P.O. Box 45, Boyers, PA 16017-0045, and to keep Part 3 in the annuitant's file.
What happens when the annuitant dies?
The agency completes Section C and sends the form to OPM. The instructions say to also send any completed Claim for Death Benefits (Form FE-6) and certified death certificate received.
Why does GSA's page show a different title?
GSA's page lists it as Certificate of Insured Employee's Retirement Status. The form itself prints Certification of Insured Employee's Retired Status.