Effective Date: 10/2002
To request information from the United States Office of Personnel Management (OPM) regarding the amount of an applicant/recipient's civil service benefits.
Number of Copies
The worker completes an original and one copy of Form H1243.
The worker mails the original to the U. S. Office of Personnel Management (the address is preprinted on the form) and keeps the duplicate in the case record. Attach Form H0003, Authorization to Furnish Information (signed by the applicant, recipient, or responsible person), to the original.
Form H1243 is kept in the case record for three years after the recipient's eligibility is denied.
From — Enter the worker's name and local office mailing address.
Applicant/Recipient Information — Enter annuitant's or dependent's name, address, and civil service retirement claim number. Enter the name of the payee, if not the annuitant.
The worker signs the form and enters the date and his telephone number. OPM staff complete the other items on the form.