Skip to page navigation
U.S. flag

An official website of the United States government

OPM.gov / Insurance / Life Insurance / Reference Materials
Skip to main content

Request for Insurance

Federal employees use this form to obtain life insurance coverage by providing medical information.

Electronic Copies:

SF 2822(PDF file)

Paper Copies:

Paper copies of this form are not available. You MUST use the downloadable Adobe Acrobat PDF version.

Control Panel