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This page has not been translated. Please go to PBGC.gov's Spanish home page for more information available in Spanish.

Esta página no ha sido traducida. Por favor vaya a la página principal del sitio de español de PBGC para ver información disponible en español.

Forms for Workers and Retirees

PBGC may ask workers and retirees to provide additional required information, as appropriate. Some of these forms may be submitted electronically via My Pension Benefits Access (MyPBA), an online service for participants to complete transactions with PBGC. For more information, see Online Transactions: My MyPBA FAQs.

Form Number
 Form Name How to Obtain Form How to Submit Information
700 Participant Application for Pension Benefits MyPBA or Customer Contact Center By mail, MyPBA
700RN Election of Retroactive Annuity Starting Date (Spousal Consent Not Required Limited circulation* By mail, MyPBA
700RSC Election of Retroactive Annuity Starting Date (Spousal Consent Required) Limited circulation* 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
703RBD Application for Elective Lump-Sum Payment, post RBD Limited circulation* By mail
703RBD-MP Application for Elective Lump-Sum Payment, post RBD (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 Customer Contact Center By mail
706 Beneficiary Application for Pension Benefits – OF (For benefits in optional form) Customer Contact Center By mail
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
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
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 Customer Contact Center By mail
716A Certification of Pension Plan Disability Status Customer Contact Center By mail
717 Benefit Inquiry Questionnaire Limited circulation* By mail
718 Installment Payment Agreement Limited circulation* By mail
720 Application for Lump-Sum Payment Customer Contact Center By mail
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 Eligible Rollover Payment – Non-Spouse Beneficiary 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 Determination PDF or Customer Contact Center Follow Form 723 instructions (page 2 of PDF)
724 Appeal of a PBGC Benefit Determination PDF or Customer Contact Center Follow Form 724 instructions (page 2 of PDF)
N/A PBGC Form COA (Change of Address) PDF or Customer Contact Center By mail, fax
IRS W-4P Withholding Certificate for Periodic Pension or Annuity Payments   Follow Change Your Federal Tax Withholding instructions
IRS W-9 Request for Taxpayer Identification Number and Certification   Follow IRS Withholding for Persons with Non-US Addresses instructions
IRS W-8BEN Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals)   Follow IRS Withholding for Persons with Non-US Addresses instructions

 

* Some PBGC forms are appropriate for certain situations and are listed as ‘limited circulation’. These forms are not accessible on PBGC’s website. 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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MyPBA

Participants in PBGC-trusteed plans can use PBGC's fast, free, and secure online service tool to apply for pension benefits, update contact information, adjust federal income tax withholding, and more.

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