SF3109

Election of Coverage - Federal Employees' Retirement System

Agency: GSA
Revision: Rev. July 1989
Fillable fields: 15
Pages: 3
Official source: GSA form page
Checked: October 20, 2026

Standard Form 3109 (SF 3109): Election of Coverage, Federal Employees Retirement System

Standard Form 3109 (SF 3109), Election of Coverage, Federal Employees Retirement System, is the form a federal employee uses to elect coverage under the Federal Employees Retirement System (FERS). It is a U.S. Office of Personnel Management (OPM) form dated July 1989, under 5 CFR 846, and formerly OPM Form 1555. GSA hosts a copy in its forms library.

The employing office gives the form to certain employees covered by the Civil Service Retirement System (CSRS) or in appointments that are not automatically covered by FERS. The form says to complete it only if you wish to elect FERS coverage, to take no action if you wish your current coverage to continue, and that an election of FERS coverage is irrevocable.

The PDF has Part 1 for the personnel office, Part 2 for the Official Personnel Folder and an Information for Employees page. You can fill it out free in your browser on this page and download the result without an account.

Top of page 1 of Standard Form 3109 (SF 3109): Election of Coverage, Federal Employees Retirement System, as printed by GSA

What's on SF 3109

Section 1: instructions for employee

A short checklist: read the information on the back, make the election in Section 4, complete Section 5, sign and date Section 6, and return the parts as the employing office instructs.

Sections 2 and 3: identity and receipt

Name, date of birth, Social Security Number, employing department or agency and its location. The signature in Section 3 verifies receipt of the form and, the form says, does not constitute an election.

Section 4: election

The employee initials a box to elect FERS coverage, covering the Basic Benefits of FERS, the Old Age, Survivors, and Disability Insurance programs of Social Security and the Thrift Savings Plan, and authorizes withholdings from pay.

Section 5: former spouse information

Asks whether a living former spouse is awarded a portion of the annuity or survivor benefits by a court order on file at OPM, with Yes, No and I don't know boxes.

Section 6: employee's certification

Signature and date, a warning citing 18 USC 1001, and a For Agency Use Only box for the date of receipt by the agency.

Part 1 repeats Sections 1 to 3 for the personnel office. Part 2 has all six sections.

How to complete SF 3109

1
Read the Information for Employees page
It explains FERS, who may elect it, when, and when coverage begins. It names the FERS Transfer Handbook, available through the employing office, as the best source of information about FERS.
2
Complete Sections 2 and 3
Type or print the identifying information and sign Section 3 to confirm receipt. Part 1 asks only for Sections 2 and 3 and goes back as the employing office instructs.
3
Initial Section 4 to elect FERS
Place your initials in the box only to elect FERS coverage. The form says the decision is irrevocable.
4
Answer Section 5
With Yes, the form says to attach OPM Form 1556, Former Spouse's Consent to FERS Election, or a request for a waiver or an extension. The information page says to mark I don't know if unsure.
5
Sign and return Parts 2 and 3
Sign and date Section 6, then return the parts according to the employing office's instructions. The form says a FERS election cancels any CSRS designation of beneficiary (SF 2808) and points to SF 3102 for a new one.

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Where it goes and what the form says

Where it goes

The PDF gives no mailing address. The employee returns it according to the employing office's instructions, and the office files the signed Part 2 on the right side of the OPF.

Election window stated on the form

The form says employees hired, or converted from an excluded appointment, on or after July 1, 1987, may elect FERS coverage within 6 months after they were hired or converted if they do not have automatic coverage.

When coverage begins

The first day of the pay period after the election is received at the location the employing office designates, unless a court order on file at OPM delays it as described on the information page.

Court orders and former spouses

The form says a spouse's consent is not needed, but a qualifying court order on file at OPM for a former spouse requires that former spouse's consent. OPM can grant an extension of time, and a waiver of the consent requirement can be requested if the former spouse cannot be located.

Privacy

Collection is authorized by the Federal Employees' Retirement System Act (Public Law 99-335). The form says furnishing the Social Security number and other data is voluntary, but failure to do so may delay or prevent a benefits determination.

Who uses SF 3109?

Reemployed CSRS employees
The employing office gives a copy to each employee reemployed after a break in service of more than three days who is covered by CSRS, either regular or offset coverage.
Appointments excluded from CSRS but not FERS
Employees whose appointment is excluded from CSRS but not from FERS and who are not automatically covered by FERS. The form gives term, TAPER and certain indefinite appointments as examples.
Employees converted to a new appointment
Employees converted from appointments excluded from FERS coverage, such as temporary appointments not to exceed one year, to appointments that are not excluded and who do not automatically have FERS coverage.
The employing office
The office files the signed Part 2 on the right side of the employee's Official Personnel Folder (OPF). If Part 2 is not received six months after the employee becomes eligible, it files Part 1 there instead.

The Instructions to Employing Office on Part 1 say which employees get a copy. The employee completes it and the employing office files it.

Official sources and the blank

Official GSA form page
The agency’s own page for Form SF3109.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form SF3109

Who issues SF 3109?

The footer names the Office of Personnel Management and 5 CFR 846. It is Standard Form 3109, dated July 1989, formerly OPM Form 1555. GSA hosts a copy in its forms library.

Does signing Section 3 mean I elected FERS?

No. The form says the signature in Section 3 verifies receipt of the form and does not constitute an election. The election is made by initialing the box in Section 4.

What if I want to keep my current coverage?

The form says to complete it only if you wish to elect FERS coverage. If you wish your current coverage to continue, it says to take no action.

Can a FERS election be undone?

The Section 4 statement and the information page both say an election of FERS coverage is irrevocable.

What happens if Section 5 is answered wrong?

The form says that if you answer No and OPM later finds a court order was on file on the date of your election, and your former spouse does not consent, your election of FERS coverage will be void.

Does a FERS election affect my beneficiary designation?

The form says that if you elect FERS, any CSRS designation of beneficiary (SF 2808) is cancelled, and that SF 3102 is used to make a new designation of beneficiary.

Standard Form 3109 (SF 3109): Election of Coverage, Federal Employees Retirement System