Fillable Form DD 2656

What is Form DD 2656?

Form DD 2656, Data for Payment of Retired Personnel, is a document used to collect information required to establish a retired or retainer pay account. It includes the designation of beneficiaries for unpaid retired pay, state tax withholding election, and dependents’ information. It is also used to establish a Survivor Benefit Plan (SBP) election.

An SBP is a Department of Defense (DoD) sponsored and subsidized program that allows a retiree to ensure a continuous lifetime annuity for his or her dependents after death.

How to fill out Form DD 2656?

Filling out Form DD 2656 is voluntary. However, failure to provide the requested information will result in delays in initiating retired or retainer pay.

PART I — RETIRED PAY INFORMATION

SECTION I — PAY IDENTIFICATION

1. NAME

Enter your name.

2. SSN

Enter your Social Security Number.

3. DATE OF BIRTH

Enter your birthdate.

4. RETIREMENT/TRANSFER DATE

Enter the date you will transfer to the Fleet Reserve or the date of retirement if you are retiring from active duty.

Enter either your 60th birth date or a later date when you want to begin receiving retired pay if you are a Reserve or National Guard member qualified to retire under 10 U.S. Code, Chapter 1223.

If you are eligible for reduced age retirement earlier than your 60th birthday, enter that date.

5. RANK/PAYGRADE

Enter your rank or pay grade.

6. BRANCH OF SERVICE

a. AIR FORCE

Mark the box if you are an air force member.

b. ARMY

Mark the box if you are in the army.

c. NAVY

Mark the box if you are a navy.

d. MARINE CORPS

Mark the box if you are a marine.

e. COAST GUARD

Mark the box if you are a coast guard.

7. MEMBER OR FORMER MEMBER OF THE

a. ACTIVE COMPONENT

Mark the box if you are or were a member of an Active or Regular Component.

b. RESERVE COMPONENT

Mark the box if you are or were a member of a Reserve Component.

8. PARTICIPANT IN THE FOLLOWING RETIREMENT PLAN

a. FINAL PAY

Mark the box if your Date of Initial Entry into Military Service (DIEMS) is before September 8, 1980.

b. HIGH-3

Mark the box if your DIEMS is on or after September 8, 1980, but before January 1.

c. CSB/REDUX

Mark the box if your DIEMS is on or after August 1, 1986, and you elected to receive the Career Status Bonus (CSB) upon completing 15 years of service.

d. BLENDED RETIREMENT SYSTEM

Mark the box if you elected to opt into Blended Retirement System, or your DIEMS is on or after January 1.

e. DISABILITY

Mark the box if you are retiring with a disability retirement regardless of your DIEMS.

9. CORRESPONDENCE ADDRESS

a. STREET

Enter the street of your correspondence address.

b. CITY

Enter the city of your correspondence address.

c. STATE

Enter the state of your correspondence address.

d. ZIP CODE

Enter the ZIP code of your correspondence address.

e. TELEPHONE

Enter the telephone number of your correspondence.

f. EMAIL ADDRESS

Enter the email address of your correspondence.

g. PREFERRED CONTACT METHOD

Mark your preferred contact method. You may mark one of the following boxes:

TELEPHONE

EMAIL

SECTION II — DIRECT DEPOSIT/ELECTRONIC FUND TRANSFER (DD/EFT) INFORMATION

ACTIVE DUTY ONLY

Mark the box if you want to continue using the financial information currently on file. If not, fill out items 10 through 13.

Note: Mark the box if you are directing your retired pay to the same account number and financial institution to which you directed your active duty pay. Attach a copy of your Direct Deposit Authorization form to establish your DD/EFT for your active duty pay.

10. ACCOUNT TYPE

Mark the appropriate box for your account type. You may choose from the following:

CHECKING

SAVINGS

11. ROUTING NUMBER

Enter the Routing Transit Number (RTN) of your bank or financial institution.

12. ACCOUNT NUMBER

Enter your account number.

13. FINANCIAL INSTITUTION

a. NAME

Enter the name of your financial institution.

b. STREET

Enter the street address of your financial institution.

c. CITY

Enter the city of your financial institution.

d. STATE

Enter the state where your financial institution operates.

e. ZIP CODE

Enter the ZIP code of your financial institution.

SECTION III — SEPARATION PAYMENT INFORMATION

14. a. PAYMENT TYPE RECEIVED

NONE

Mark the box if you did not receive any payment.

VOLUNTARY SEPARATION INCENTIVE (VSI)

Mark the box if you received a Voluntary Separation Incentive.

SEVERANCE PAY (SE)

Mark the box if you received a Severance Pay.

READJUSTMENT PAY (RP)

Mark the box if you received a Readjustment Pay.

SPECIAL SEPARATION BONUS (SSB)

Mark the box if you received a Special Separation Bonus.

SEPARATION PAY (SP)

Mark the box if you received a Separation Pay.

OTHER

Mark the box if you received other payment types.

b. GROSS AMOUNT

If you marked any of the boxes above, enter the gross amount.

List Of Attachments

If you marked any payment type, attach a copy of the orders that authorized the payment and a copy of your previous Form DD 214.

MEMBER NAME

Enter your name.

SSN

Enter your Social Security Number.

SECTION IV — VETERANS AFFAIR (VA) DISABILITY COMPENSATION INFORMATION

15. VA DISABILITY COMPENSATION

a. IN THE EVENT I AM AWARDED DISABILITY COMPENSATION BY THE VA, I WILL NOT NOTIFY DFAS OF THE AMOUNT OF ANY AWARD, AS IT MAY IMPACT MY RETIRED PAY BENEFIT.

Agree

Mark the box if you agree.

Note that all retirees must acknowledge item 15a. If you later apply for and are awarded VA disability compensation, you must notify the Defense Finance and Accounting Service (DFAS) of the awarded amount.

b. HAVE YOU APPLIED FOR OR ARE YOU RECEIVING VA COMPENSATION FOR A DISABILITY?

Yes

Mark the box if you have applied for or previously received VA compensation for a disability. Then, complete items 15.c and 15.d.

No

Mark the box if you have not applied for or previously received VA compensation for a disability.

c. EFFECTIVE DATE OF PAYMENT

Enter the effective date of payment.

d. MONTHLY AMOUNT OF PAYMENT

Enter the monthly amount of payment.

SECTION V — DESIGNATION OF BENEFICIARIES FOR UNPAID RETIRED PAY

Mark the box if you choose to designate your spouse as the primary beneficiary for 100% of your unpaid retired pay. If so, leave items 16.a through 16.e blank.

If you choose to designate a different beneficiary or beneficiaries, complete items 16.a through 16e.

16. BENEFICIARY OR BENEFICIARIES INFORMATION

a. NAME

Enter the name or names of your beneficiary or beneficiaries.

b. SSN

Enter the Social Security Number of your beneficiary or beneficiaries.

c. ADDRESS

Enter the address of your beneficiary or beneficiaries.

d. RELATIONSHIP

Enter your relationship with your beneficiary or beneficiaries.

e. SHARE

Enter the percentage of share each beneficiary will get.

SECTION VI — FEDERAL INCOME TAX WITHHOLDING INFORMATION

Complete this section after determining your allowed exemptions with the aid of your disbursing or finance office.

Do not fill out items 17 through 19 if you are completing item 20.

17. MARITAL STATUS

Mark the marital status you want to claim.

SINGLE

Mark the box if you are single.

MARRIED

Mark the box if you are married.

MARRIED BUT WITHHOLD AT HIGHER SINGLE RATE

Mark the box if you are married but withhold at a higher single rate.

18. TOTAL NUMBER OF EXEMPTIONS CLAIMED

Enter the number of exemptions you claimed.

19. ADDITIONAL WITHHOLDING

Enter the amount of additional federal income tax you want to withhold from each pay. Do not enter anything if you do not want an additional withholding.

20. I CLAIM EXEMPTION FROM WITHHOLDING

Enter EXEMPT if you:

21. ARE YOU A UNITED STATES CITIZEN?

Yes

Mark the box if you are a U.S. citizen.

No

Mark the box if you are not a U.S. citizen. Then, provide an additional sheet containing a list of all your periods of active duty served in the continental U.S., Alaska, and Hawaii.

Follow this format:

FROM (Year/Month) DUTY STATION TO (Year/Month)

1994/02 NAVSTA, Norfolk, VA 1995/01

SECTION VII — VOLUNTARY STATE TAX WITHHOLDING INFORMATION

Complete this section if you want monthly state tax withholding.

Note: If you choose not to have a monthly deduction, you remain liable for state taxes, if applicable.

22. STATE DESIGNATED TO RECEIVE TAX

Enter the state where you want your tax to be withheld.

23. MONTHLY AMOUNT

Enter the monthly amount of tax you want to be withheld from your monthly retired or retainer pay.

24. RESIDENCE ADDRESS

Do not enter anything if your residence address is the same as the address in item 9.

If different, complete items 24.a through 24.d.

a. STREET

Enter the street of your residence address.

b. CITY

Enter the city of your residence address.

c. STATE

Enter the state of your residence address.

d. ZIP CODE

Enter the ZIP code of your residence address.

MEMBER NAME

Enter your name.

SSN

Enter your Social Security Number.

PART II — LUMP SUM ELECTION

Complete Part II if you are covered under the Blended Retirement System and want to elect a partial lump sum of retired pay.

SECTION VIII — BLENDED RETIREMENT SYSTEM LUMP SUM ELECTION

25. LUMP SUM PERCENTAGE

If you do not mark any of the boxes below, you default to receiving your full retired pay on a monthly basis.

a.

Mark the box if you elect to receive a 25 percent lump sum that is a discounted portion of your retired pay for the period from when you are eligible to begin receiving retired pay until you reach full social security retirement age.

b.

Mark the box if you elect to receive a 50 percent lump sum that is a discounted portion of your retired pay for the period from when you are eligible to begin receiving retired pay until you reach full social security retirement age.

26. LUMP SUM PAYMENTS

Complete this item if you marked a box on item 25.

a. ONE INSTALLMENT

Mark the box if you want to receive a lump sum of your retired payment in one installment.

b. TWO EQUAL ANNUAL INSTALLMENTS

Mark the box if you want to receive a lump sum of your retired payment in two equal annual installments.

c. THREE EQUAL ANNUAL INSTALLMENTS

Mark the box if you want to receive a lump sum of your retired payment in three equal annual installments.

d. FOUR EQUAL ANNUAL INSTALLMENTS

Mark the box if you want to receive a lump sum of your retired payment in four equal annual installments.

27. LUMP SUM CONSIDERATIONS

Read this item before signing Form DD 2656.

28. LUMP SUM ACKNOWLEDGEMENT

Complete this item if you have marked items 25 and 26.

a. MEMBER SIGNATURE

Enter your signature.

b. DATE SIGNED

Enter the date upon signing Form DD 2656.

MEMBER NAME

Enter your name.

SSN

Enter your Social Security Number.

PART III — SURVIVOR BENEFIT PLAN

SECTION IX — DEPENDENCY INFORMATION

Complete this section regardless of SBP Election.

29. SPOUSE

Enter your spouse's information. If you do not have one, enter N/A and proceed to item 32.

a. NAME

Enter the name of your spouse.

b. SSN

Enter the Social Security Number of your spouse.

c. DATE OF BIRTH

Enter the birthdate of your spouse.

30. DATE OF MARRIAGE

Enter the date when you and your spouse got married.

31. PLACE OF MARRIAGE

Enter the place where you and your spouse got married.

32. DEPENDENT CHILDREN

Enter your dependent child or children's information. If none, enter N/A.

a. NAME

Enter the name or names of your dependent child or children.

b. SSN

Enter the Social Security Number of your dependent child or children.

c. DATE OF BIRTH

Enter the birth date or birth dates of your dependent child or children.

d. RELATIONSHIP

Enter your relationship with your dependent child or children. If any of them resulted from marriage to a former spouse, enter FS after the relationship.

e. DISABLED?

Yes

Mark the box if your dependent child or children is or are disabled.

No

Mark the box if your dependent child or children is or are not disabled.

SECTION X — SURVIVOR BENEFIT PLAN (SBP) ELECTION

Note:

33. RESERVE COMPONENT ONLY

The information needed to complete this item can be found on your Form DD 2656-5, Reserve Component Survivor Benefit Plan (RCSBP) Election Certificate.

OPTION A

Mark the box if you previously declined to make an election until eligible to receive retired pay. Then, proceed to item 34 to make an election.

OPTION B

Mark the box if you previously elected coverage to begin at age 60. If so, do not make an election in item 34.

OPTION C

Mark the box if you previously elected or defaulted to immediate RC-SBP Coverage. If so, do not make an election in item 34.

Yes

Mark the box if your marital status has changed since your initial election to participate in RC-SBP.

No

Mark the box if your marital status has not changed since your initial election to participate in RC-SBP.

34. SBP BENEFICIARY CATEGORIES

a. I ELECT COVERAGE FOR SPOUSE ONLY

Mark the box to elect coverage for your spouse. If you have dependent children or a child, mark Yes. If none, mark No.

b. I ELECT COVERAGE FOR SPOUSE AND CHILD(REN)

Mark the box to elect coverage for your spouse and children.

c. I ELECT COVERAGE FOR CHILD(REN) ONLY I have a Spouse Yes No

Mark the box to elect coverage for your child or children. Mark Yes if you have a spouse. If none, mark No.

d. I ELECT COVERAGE FOR THE PERSON NAMED IN BLOCK 37 WHO HAS AN INSURABLE INTEREST IN ME

Mark the box to elect coverage for the person in item 37 who has an insurable interest in you.

e. I ELECT COVERAGE FOR MY FORMER SPOUSE INDICATED IN BLOCK 38

Mark the box to elect coverage for your former spouse in item 38.

f. I ELECT COVERAGE FOR MY FORMER SPOUSE AND DEPENDENT CHILD(REN) OF THAT MARRIAGE

Mark the box to elect coverage for your former spouse and dependent child or children of that marriage.

g. I ELECT NOT TO PARTICIPATE IN SBP

Mark the box if you decline coverage under SBP. If you have eligible dependents under the plan, mark Yes. Then, enter the spouse concurrence in Part V. If none, mark No.

35. SBP LEVEL OF COVERAGE

a. I ELECT COVERAGE BASED ON FULL GROSS PAY

Mark the box if you want the coverage to be based on your full gross retained or retainer pay.

b. I ELECT COVERAGE WITH A REDUCED BASE AMOUNT OF $

Mark the box if you want the coverage to be based on a reduced portion of your gross retained or retainer pay. Then, enter the amount.

c. CSB/REDUX MEMBERS ONLY

This item is for REDUX members who want to base their coverage on actual retired pay received under REDUX. If you marked this item, proceed to Section XII if married.

I elect coverage based on my actual Reduced Retired Pay Under REDUX.

Mark the box to elect coverage based on your actual Reduced Retired Pay under REDUX.

I understand that this represents a Reduced Base Amount and requires Spouse Concurrence.

Mark the box if you understand that this represents a Reduced Base Amount and requires Spouse Concurrence.

d. I ELECT COVERAGE BASED ON THE THRESHOLD AMOUNT IN EFFECT ON THE DATE OF RETIREMENT

Mark the box to elect coverage based on the threshold amount in effect on the date of your retirement.

MEMBER NAME

Enter your name.

SSN

Enter your Social Security Number.

36. SPECIAL NEEDS TRUST

Mark the box if you intend to designate a Special Needs Trust (SNT) as a beneficiary for the child or children designated as disabled in item 32.

37. INSURABLE INTEREST BENEFICIARY

If you have an eligible spouse or former spouse, do not leave this item blank.

a. NAME

Enter the name of your insurable interest beneficiary.

b. SSN

Enter the Social Security Number of your insurable interest beneficiary.

c. DATE OF BIRTH

Enter the birthdate of your insurable interest beneficiary.

d. RELATIONSHIP

Enter your relationship with your insurable interest beneficiary.

e. STREET

Enter the street address of your insurable interest beneficiary.

f. CITY                 

Enter the city of your insurable interest beneficiary.

g. STATE

Enter the state where your insurable interest beneficiary lives.

h. ZIP CODE

Enter the ZIP code of your insurable interest beneficiary.

i. TELEPHONE

Enter the telephone number of your insurable interest beneficiary.

j. EMAIL ADDRESS

Enter the email address of your insurable interest beneficiary.

38. FORMER SPOUSE INFORMATION

If you have a former spouse, enter his or her information.

a. NAME

Enter the name of your former spouse.

b. SSN

Enter the Social Security Number of your former spouse.

c. DATE OF BIRTH

Enter the birthdate of your former spouse.

d. DATE OF DIVORCE

Enter the date when you and your former spouse got divorced.

e. TELEPHONE

Enter the telephone number of your former spouse.

f. EMAIL ADDRESS

Enter the email address of your former spouse.

PART IV — CERTIFICATION

SECTION XI — CERTIFICATION

Sign Form DD 2656 for your SBP election to be valid.

39. MEMBER

a. NAME

Enter your name.

b. SIGNATURE

Enter your signature.

c. DATE SIGNED

Enter the date upon signing Form DD 2656.

40. WITNESS

Your witness must not be your beneficiaries in Sections V, IX, and X.

a. NAME

Enter the name of your witness.

b. SIGNATURE

Enter the signature of your witness.

c. DATE SIGNED

Enter the date your witness has signed Form DD 2656.

d. UNIT OR ORGANIZATION ADDRESS

Enter the unit or organization address of your witness.

e. CITY/BASE OR POST

Enter the city, base, or post of your witness.

f. STATE

Enter the state where your witness lives.

g. ZIP CODE

Enter the ZIP code of your witness.

PART V — SPOUSE SBP CONCURRENCE

Complete this part if you:

41. SPOUSE

a. NAME

Enter the name of your spouse.

b. SIGNATURE

Enter the signature of your spouse.

c. DATE SIGNED

Enter the date your spouse has signed Form DD 2656.

42. NOTARY WITNESS

A notary public must witness the signature of your spouse in item 41.

On this day of

Enter the date when the notary public has witnessed your spouse signing Form DD 2656.

Signature of Notary

Enter the signature of the notary.

My Commission Expires

Enter the expiration date of the notary's commission.