Military Retiree Casualty Assistance Checklist

As of date __________________

Retirees Name___________________________________ SSN______________________________

Military Grade ______________ Date of Retirement ______________ Branch of Service _________ Years of Service __________

Address_____________________________ City ___________________State _____ ZIP ______

Spouse's Maiden Name ________________________________________ DOB _______________

Place of Birth ________________________________________________________________

Date of Marriage __________________ Place of Marriage __________________________________

Father's Name _____________________________________________ DOB _________

Place of Birth ___________________________________

Mother's Maiden Name ______________________________________ DOB _________

Place of Birth ___________________________________

Documents needed to claim death benefits (Check them off and note location of each)

__ Copies of report(s) of separation from active duty (DD Form 214, etc.) ______________________

__ Copies of retirement orders _______________________________________________________

__ Copies of birth and death certificates ________________________________________________

__ Beneficiaries birth certificate(s) and marriage and/or divorce data ___________________________

__ Social Security data (see Part III)

__ VA insurance data (See Part I )

Plus -- You should always have the following documents on hand (note location of each):

Updated will and letter of instructions ___________________________________________________

Names of banks, credit unions, etc. (account numbers) ______________________________________

Updated list of assets and liabilities _____________________________________________________

Insurance policies, numbers, instructions, payments, etc ______________________________________

Adoption or naturalization papers (if applicable) ____________________________________________

Part 1 - Veterans Administration Data (if applicable)

VA Compensation $ _____________________ Disability claim # _____________________________

Remarks _________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

VA Insurance policy Nr(s) _______________________________ File Nr _______________________

Type________________________ Amount $____________ /_____________

Location of policies ________________________________

Any known paid-up add'l VA Insurance $___________________ As of Date _____________________

Other Remarks ___________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Veteran's claim Nr(s) (other) ______________________ Patients data card #_____________________

Part II - Retirement Pay Data (see retiree account statements)

Retiree pay data: (as of date) ____________________________________________

Gross pay $ ________________________

Deduction $ ____________________________ For____________________________________

Deduction $ ____________________________ For____________________________________

Deduction $ ____________________________ For_____________________________________

Deduction $ ____________________________ For _____________________________________

Net Pay $ _____________________Taxable Income $ ___________________________

Survivor coverage Information

Survivor benefit plan annuity $ ______________________SBP Base Amount $ _________________

Supplemental SBP (if any) $ _______________Effective _________________

RSFPP annuity $____________________

Part III - Social Security (when Applicable)

Social Security Claim # __________________________________ Month filed _________________

Type of benefit(s)___________________________ Beginning month of entitlement______________

Amount monthly $____________________ Bank and acct. # (direct deposit)____________________

Note: No payment is payable for the month of death (call local SSA office)

Part IV - Miscellaneous (Things to know and plan for upon death of a retiree)

• Disposition instructions for the body (burial, cremation, memorial service, etc.)

• Information required for Death Certification. (Date/Place of birth, Father's Name, Mother's Maiden Name, etc.)

• Information required for obituary notice (names, relation & locations of appropriate relatives, etc.)

• Widows will need a new ID card (military, medical, commissary, base exchange, etc.)

• Necessary changes in your DEERS program will have to be made (CHAMPUS, etc.)

• It may take several months to clear estates (you may require at least 8 copies of death certificate)

• Contents of your safety deposit box should be known (and make sure the box number, its location and location of key are known)

• Direct deposit of Social Security benefits & military retirement payments (entitlements) must be immediately changed

• Named beneficiaries on insurance policies become very important (keep current)

• There may be some entitlement to burial benefits (headstone, payments, etc.) (Check VA)

• Check VA for Presidential Memorial Certificate

• An American flag can be obtained (check VA and Post Office)

• The survivor should update appropriate will

• Extra credit cards should be destroyed or canceled

• Appropriate changes should be made to all joint ownerships

• Contact insurance companies as appropriate

• Be prepared to turn in Retirees ID Card (Where and when required)

Fill in and keep the following office phone numbers (Update periodically):

Casualty Assistance__________(LAFB 764-5231)  Retiree Activities__________(LAFB 764-7386)

Hospital (Military)__________Legal Office (Military)__________(LAFB 764-3277)

VA Hotline1-800-827-1000  Social Security Hotline1-800-772-1213

Family Sup Ctr_______(LAFB 764-3990)  ID Card/DEERS Renewal_________(LAFB 764-2276)

Finance (Retiree Pay)__________(LAFB 764-3333)  SBP__________(LAFB 764-5231)

Note: Spouse/Next of Kin should have a copy of this document or know where to locate it. Consider letting a third party (family member) know where it is in case something should happen to both the retiree and spouse or Next of Kin at the same time.