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.
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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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