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Effective Date: 



Updated: 10/2002


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


When to Prepare

The worker prepares Form H1214 to request benefit information from the military or private pension source.

Number of Copies

The worker prepares an original and two copies.


The worker mails the original and first copy to the pension source. He retains the second copy in the case folder. When the reply is received, he destroys the copy.

The pension source's staff completes Form H1214 and returns the original to the worker.

Form Retention

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