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Effective Date: 



Updated: 12/2010


To provide a means of requesting the amount of pension benefits paid to a beneficiary.


When to Prepare

Prepare Form H1214-FTI to request benefit information from the military or private pension source.

Number of Copies

Prepare an original and two copies.


Mail the original and first copy to the pension source and retains the second copy in the case folder. When the reply is received, destroy the copy.

The pension source's staff complete Page 2 of Form H1214-FTI and return the original to the eligibility specialist.

Form Retention

Completed original Form H1214-FTI is kept in the case folder for three years after denial of the client.

Detailed Instructions


Federal Tax Information — If the request is based on information obtained on an Automated System for the Office of Inspector General (ASOIG) Match Worksheet, check the Yes box. Do not include a copy of the ASOIG Match Worksheet with the request. If the request is not based on information obtained on an ASOIG Match Worksheet, check the No box.

Sign on Page 1, and enter the date and local office telephone number. Enter the Return Form To: information on Page 2. The pension source representative completes all other items on Page 2.