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 or What Information to File	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
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	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

* 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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Last Updated: April 12, 2022

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