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Workers & Retirees

Forms for Workers and Retirees

In some instances, the required information is entered electronically via MyPBA, a secure Web site that enables participants in PBGC-trusteed plans to complete a number of transactions online. For more information, see Online Transactions are Easy with MyPBA [PDF].

Form Number

Form Name

How to Obtain Form or What Information to File

How to Submit Information

700

Participant Application for Pension Benefits

MyPBA or Customer Contact Center

By mail, MyPBA

701

Payee Information Form (PIF)

MyPBA, PDF, or Customer Contact Center

By mail, MyPBA

702

General Information Form (GIF)

Limited circulation*

By mail

703

Application for Elective Lump-Sum Payment

Limited circulation*

By mail

703MP

Application for Elective Lump-Sum Payment (For Missing Participants)

Limited circulation*

By mail

704

Report of Earnings and Social Security Disability Information

Limited circulation*

By mail

705

Beneficiary Application for Pension Benefits

MyPBA or Customer Contact Center

By mail, MyPBA

706

Beneficiary Application for Pension Benefits – OF (For benefits in optional form)

MyPBA or Customer Contact Center

By mail, MyPBA

707

Designation of Beneficiary for Benefits Owed at Death (Currently Receiving Pension Benefits)

MyPBA, PDF, or Customer Contact Center

By mail, MyPBA

708

Designation of Beneficiary (Not Currently Receiving Pension Benefits)

MyPBA, PDF, or Customer Contact Center

By mail

709

Plan Participation Information

Limited circulation*

By mail

710

Application for Electronic Direct Deposit

MyPBA, PDF, or Customer Contact Center

By mail, MyPBA

711

Change of Beneficiary for Certain & Continuous (C&C) Benefits Only

PDF, or Customer Contact Center

By mail, MyPBA

712

Uniformed Services Information Form

Limited circulation*

By mail

713

Election to Withdraw Employee Contributions

Limited circulation*

By mail

714

Withdrawal of Employee Contributions - Non Spouse Beneficiary

Limited circulation*

By mail

715

Power of Attorney Form

PDF or Customer Contact Center

By mail

716

Certification of Social Security Disability Status

MyPBA, Customer Contact Center

By mail, MyPBA

716A

Certification of Pension Plan Disability Status

MyPBA, Customer Contact Center

By mail, MyPBA

718

Installment Payment Agreement

Limited circulation*

By mail

719

Election to Withhold Federal Income Tax (FIT) from Periodic Payments

MyPBA, PDF, or Customer Contact Center

By mail, MyPBA

720

Application for Lump-Sum Payment

MyPBA, Customer Contact Center

By mail, MyPBA

720CD

Application for Lump-Sum Payment (Child or Other Dependant QDRO)

Limited circulation*

By mail

720MP

Application for Lump-Sum Payment (Missing Participants)

Limited circulation*

By mail

721

Application for Lump-Sum Payment – Non-spouse Beneficiary or Estate

Limited circulation*

By mail

721T

Tax Election for Payment Not Eligible for Rollover

Limited circulation*

By mail

722

Financial Statement of Debtor

Limited circulation*

By mail

723

Request for Additional time to file an Appeal of a PBGC Benefit Termination

PDF or Customer Contact Center

Follow Form 723 instructions (page 2 of PDF)

724

Appeal of a PBGC Benefit Termination

PDF or Customer Contact Center

Follow Form 724 instructions (page 2 of PDF)

* Some PBGC forms are appropriate for only a limited number of individuals. These forms are not accessible on PBGC’s Web site. If you think that you may need such a form, please call PBGC’s Customer Contact Center so that a PBGC specialist may determine if the form is appropriate for you.

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