Form 2676: Fill out & sign online

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In Section I, enter your name (LAST, First, Middle Initial) and check the box if you have a new address. Fill in your current home address, including street, city, state, and zip code.
Provide your telephone numbers: home and daytime. Then, enter your Social Security Number and select your branch of service by checking the appropriate box.
Indicate your date of retirement in YYYYMMDD format. Specify the type of employment reported by checking NEW, ANNUAL, END OF JOB, or FINAL.
Answer whether you have served on active duty since the beginning of this period of qualifying employment by selecting YES or NO.
In Section II, your employer will need to fill out their information including organization name and contact details. They must also certify the dates of your full-time employment.
Finally, in Section III, sign and date the certification to confirm that all provided information is accurate.

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