Application for Death Benefits OMB number 3206-0172 Federal ...-2025

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  1. Click ‘Get Form’ to open the Application for Death Benefits in the editor.
  2. Begin with Section A, providing information about the deceased. Fill in their full name, date of birth, date of death, and Social Security Number. Attach a certified copy of the death certificate.
  3. In Section B, enter your details as the applicant. Indicate your relationship to the deceased and check all applicable boxes regarding your status (e.g., spouse, executor).
  4. Proceed to Section C if you are the surviving spouse. Provide marriage details and any previous marriages that may affect your application.
  5. Complete Sections D through G by providing information about former spouses, dependent children, and other heirs as required. Ensure all necessary documentation is attached.
  6. Review Section I for direct deposit options and complete Section J by certifying that all information is accurate before submitting your application.

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Who is Eligible? Most Canadians who have worked and paid into CPP will be eligible to receive this benefit. The specific requirements are identified as: The deceased must have worked in Canada and contributed to CPP for a minimum of 10 calendar years OR a third of the calendar years in their contributory period.
CPP Death Benefit is a one-time payment payable to the estate or other eligible individuals, on behalf of a deceased CPP contributor. CPP Death Benefit Application Form. CPP Survivors Pension is a monthly payment paid to the legal spouse or common-law partner of the deceased contributor.
Death Certificate duly registered with LCR or issued by the PSA of the following, whichever is applicable: Birth Certificate of the deceased member. Joint Affidavit (CLD-1.3) preferably by the relatives of the deceased member. For legal heirs, birth certificate of at least two (2) legal heirs.
Applications may be obtained online at opm.gov/retire or by contacting the Retirement Information Office at 1-888-767-6738. For survivors of employees or retirees covered under the Federal Employees Retirement System (FERS), please complete SF 3104, Application for Death Benefits (FERS).