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Does a survivor appear eligible for a monthly annuity Yes go to item 2 c. Is there a surviving spouse eligible for the Basic Employee Death Benefit Yes complete SF 3104B Section 3 Page 6 No go to Part 4 a. When was the life insurance certified to the Office of Federal Employees Group b. NSN 7540-01-351-9169 3104-302 Standard Form 3104B Revised April 2012 Agency Instructions A certified copy of this form must accompany an Application for Death Ben.

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