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Fegli beneficiary Form: What You Should Know

Personal Information ; Subseries A : Employee information;¬†Subseries B: Beneficiary's information;¬†Subseries C : Beneficiary's address;¬†Subseries D : Social Security number;¬†Subseries E : Other information required in Form SS-5;¬†Subseries F : Beneficiary's designations;¬†Subseries G : Date of Birth;¬†Subseries H : Beneficiary's Employer Identification Number;¬†Subseries I : Beneficiary's Employer Information (EIN);¬†Subseries J : Social Security Number;¬†Subseries K : Contact information for contact with the plan administrator (Plan Administering Agent) for the deceased individual; and¬†Subseries L : Death Beneficiary Identification Number (BIN); All Other Information Collection Requirements: (1) For purposes of this report, the term ‚Äúother information collection‚ÄĚ means any collection of a record that pertains not only to individuals but that also refers to some type of group of individuals.¬†(2) For purposes of this report, the term ‚Äúpersonal information‚ÄĚ means information that identifies an individual, and includes, for example, name, identification number(s), phone numbers, driver's license number, taxpayer ID number (TIN), address or mailing address, employer identification number (EIN) of the deceased individual(s), and other information.¬†(3) For purposes of this report, the term ‚Äúrecipient‚ÄĚ of a notice, including a beneficiary, or a representative of a beneficiary, means the individual(s) to whom any information is provided during the course of an information collection, as described in the notice for which the information collection is being made.¬†(4) Information is collected to determine if a beneficiary is deceased.¬†Information is collected to determine the beneficiary's information and the type of beneficiary.¬†If the individual has provided no other information, information is collected only to determine if the individual died or to determine the beneficiary's information.¬† NOTE: If a beneficiary's address, Social Security number (SSN), or the date of birth is different from the information on file, the information can be obtained by calling the Federal Insurance Office of Social Security (FLOSSES). For these calls, call from any U.S. or Canadian telephone.

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