** Final DD Form 214, Certificate of Release or Discharge from Active Duty

** Retirement Order

** Statement of Service

** Military Pay Record

** NOTE: For Retired Reserve - Non full-time Military

• Survivor Benefit Plan Election - obtain from Military Pay Record

• Retiree's ID card - Dependent ID cards must be reissued

Medical Records - if service disability claimed or being claimed

Veteran Administration "C" Number, if established and Letter stating percentage of disability

Social Security Number - all family members

Deceased retiree's will

Birth Certificate - all family members

Adoption and Custody documents

Marriage and Divorce documents

Immigration and Naturalization papers

Income Tax Records

Insurance policies - Life, home, auto, boat, etc.

Copy of Deeds, Abstracts, Mortgages, etc.

Titles and Registrations - Auto, Boat, etc.

List of Safety Deposit Box(es) and location.

List of all Bank Accounts, Checking, Savings, etc., and location.

List of Credit Cards in deceased's name.

List of Outstanding Debts.

List of Monies, Property, etc. due estate.

Additional Assistance to the Survivor - Depending on the situation, i.e., whether more help is wanted or desired, the MRSAT member could either contact the following agencies or advise the survivor that they should be contacted within a reasonable time:

• Funeral Director for Death Certificates - at least 25 are recommended, all showing cause of death.
• Retirement Pay/Settlement
• SBP Annuity
• New ID Cards will be necessary
• Banks, Credit Unions - It is advisable to keep the joint account open where the retiree's pay, Social Security and other forms of income that were on direct deposit were held until all pay, allowances and survivor benefits related to the retiree's death are completely settled.
• Home, auto, etc., Insurance Firms
• Former employers for Survivors Benefits Information
• Veterans Administration
• Social Security - for Survivors Benefits Information
• NSLI, Com/insurance
• Stock Brokers, Investments
• Mortgage holders, etc.

The residual pay application and the RSFPP/SBP/RCSBP/SSBP annuity application process is set in motion with the notification of the appropriate service branch ( see page 4). The MRSAT team member can advise the next of kin that the following forms will be delivered to them and will need to be prepared reasonably soon so that their claims can be processed. The Patrick AFB Casualty and SBP Representative will prepare and submit these forms for survivors whose sponsors served in the U. S. Air Force. All other services will, upon notification of a retiree's death, send all the necessary forms and possibly will supply a trained Casualty Assistance person to help in their preparation. The MRSAP team member should advise the survivor that they will assist in the preparation of these forms when they are received if necessary

• Standard Form 1174 CLAIM FOR UNPAID COMPENSATION OF DECEASED MEMBER OF THE UNIFORMED SERVICES. Mail completed forms to:

                    DFAS-CL/U.S. MILITARY RETIREMENT PAY

                    P.O. BOX 7130

                    LONDON, KY 40742-7130

• DD Form 1884 APPLICATION FOR ANNUITY UNDER RSFPP OR SBP. Mail the completed form to:

                    DFAS/CK/U.S. MILITARY ANNUITANT PAY

                    P.O. BOX 7131

                    LONDON, KY 40242-7131

• IRS form W-4P WITHHOLDING CERTIFICATE FOR PENSION OR ANNUITY PAYMENTS. Attach the completed form to the DD Form 1884 for mailing.

• FMS Form 2231 FASTSTART DIRECT DEPOSIT. Attach the completed form to the DD Form 1884 for mailing.

• VA Form 29-4125 CLAIM FOR ONE SUM PAYMENT. Attach a death certificate and mail to:

                    VA INSURANCE CENTER

                    P.O. BOX 7208

                    PHILADELPHIA, PA 19101

                    NOTE: For expediency, this form and the death certificate can be faxed to 215-381-3561, but a hard copy should also be mailed.

OTHER MILITARY SURVIVOR BENEFITS

Survivors should become familiar with government benefits and know what aid to expect as regards the benefits that follow. Most of these benefits are explained in detail in TROA's "Help your surviving Spouse - Now" pamphlet, and additional help and information can be obtained from one of the agencies listed in Appendix 3.

• Survivor Annuity (SBP)

• Civil Service Preference

• Commissary and Base Exchange privileges

• Recreation and other Base Facilities

• Social Security

• Arrears of Pay

• Burial Benefits

• Financial Aid (AF Aid Society)

• TROA Auxiliary Membership

• Continue Military Life Style with Military Families


 

WILLS AND SETTLEMENT OF ESTATE

State of Florida Probate Laws and Florida State Supreme Court rules govern disposition of estates in Florida. Surviving spouse should contact their attorney or the Brevard County Clerk of Circuit Courts Probate Division on requirements. Possible sources of assistance are:

• John C. Murphy, LTC, FLARNG, former TROACC President, Attorney-at-Law in Melbourne, phone 676-2525, offers an initial probate counseling free of cost to all survivors of deceased military retirees in Brevard County, regardless of rank or service branch. To gain maximum benefit of no cost visit, survivor should make list of legal matters to be discussed and assemble relating documents/papers prior to telephoning for appointment. If some legal services are required beyond initial counseling, Colonel Murphy is a member of the TROA Legal Services which provides for a 25% discount from usual fees.

• The 45^th Space Wing Office of the Staff Judge Advocate in building 562, phone 494-7357, can be of assistance to survivors with valid ID cards who have general questions in estate and probate matters, and can prepare simple wills, medical directives, health care surrogates and durable powers of attorney. Attorneys are available on Monday and Wednesday between 0800 and 1000 (active duty members in uniform are given priority). The Legal Office also offers its Legal Assistance Guide which addresses certain estate and probate matters free of charge to clients.

• The Brevard County Bar operates a Lawyer Referral Service, phone 631-2500, for referring persons to lawyers who practice in specialized areas of law such as estate planning and probate affair. Free legal service should not be expected from this source.

MEDICAL CARE AND INSURANCE FOR SURVIVORS

Medical care benefits vary considerably depending on the age of the survivor. Generally, a surviving spouse under age 65 is eligible to receive medical care under DoD's Tricare Program, and Medicare-eligible survivors who are enrolled in Medicare Part B are eligible for both the Tricare Senior Pharmacy Program (TSRx) and Tricare-For-Life which is a cost-free supplement to Medicare. Details of these programs are covered in great detail in TROA's "Help your surviving Spouse - Now" pamphlet.

• The Health Care Insurance Law-Copra Act of 1985.

After retirement from military service many enter a second career in which the new employer provides health care coverage on the retiree and family at little or no cost. Many then drop their supplemental health care policies. Often, upon death of the retiree the new employer terminates the insurance and the family is without a much needed supplemental health care coverage. Survivors under age 65 should immediately obtain some type of supplemental coverage to TRICARE.

The COBRA Act of 1985 (Federal Law) requires businesses with over 20 employees, except the federal government, upon request of the survivors, to continue health care coverage on deceased retiree's dependents for 18 to 36 months at a rate of not more than 102% of premium paid by both the employer and the deceased. This coverage also applies to employees who voluntary resign, get laid off or discharged for anything other than gross misconduct.

This coverage is not automatic. Survivors must request the coverage.

• Tricare/Medicare Limitations

Tricare Stops Payments after Initial 90 Day Hospitalization. Thereafter, approves for each 30 day additional period after approving request for each additional period.

Medicare Stops Payments after Initial 60 Day Hospitalization. Thereafter, approves for each 30 day additional period after approving request for each additional period.

NOTE: Hospital stays less than 90 days apart for Tricare and 60 days apart for MEDICARE are accumulative toward the above cited limitation period.

• Tricare Claims for the Deceased

All Tricare claims must be submitted within one year from the date the service is provided or, for inpatient care, within one ear from a patient's date of discharge from an inpatient facility. The Department of Defense TRICARE office has informed us that if a retiree (or other eligible beneficiary) is deceased the TRICARE claim form must be signed by the legal representative of the estate, as CHAMPUS checks are issued to the individual who signs the claim form. Documentation must accompany the claim form to show that the person signing is the legal representative. This means widows cannot submit claim forms unless they are the legal administrators of the estate.

• Medicare Claims for the Deceased

Survivors can obtain appropriate forms and directions on filing MEDICARE claims for deceased from the local Social Security office.

Appendix 1. FORMS THAT WILL BE USED BY MRSAP TEAM MEMBERS

• MRSAP Form 1 - DEATH INFORMATION CHECKSHEET provides an orderly and complete means of collecting the essential information about the deceased, and for making all the initial reports of the person's death. Almost all the information required for the other forms and reports will be collected here. Team members should have this form readily available and should start filling in the information immediately upon being asked to assist a survivor.

RAO/45 SW & TROACC

MRSAP DEATH INFORMATION CHECKSHEET

Information on this page is subject to the provisions of

the Privacy Act of 1947 and will be protected accordingly.

****** DECEDENT ******

DATE CONTACTED: REPORTED BY: CAR'S INITIALS

LAST NAME: FIRST MIDDLE:

*RANK: SSAN: DATE RETIRED: SERVICE:

DATE OF BIRTH: PLACE OF BIRTH:

DATE OF DEATH: PLACE OF DEATH:

CAUSE OF DEATH (UNCONFIRMED):

****** SURVIVOR ******

PNOK: RELATIONSHIP:

SSAN: PLACE OF MARRIAGE:

DATE OF BIRTH: PLACE OF BIRTH:

LOCAL ADDRESS:

HOME PHONE: WORK PHONE:

STATE OF LEGAL RESIDENCE:

****** ADDITIONAL INFORMATION ******

SBP: DRAPES: DEERS:

_{(YES/NO) (YES/NO)(CAR INITIALS)}

ELIGIBLE CHILDREN:

_{(NAME, SSAN, AGE, DOB, ADDRESS)}

PARENTS: LIVING: (Name and address, if alive)

REMARKS:

MRSAP Form 1 15 September 2002 Page 1 of 1

• MRSAP Form 2 - MRSAP SURVIVOR'S WORKSHEET is a eight (8) page handout that becomes the property of the next of kin and serves as a checklist and means of recording the actions taken by the team member, the next of kin or anyone else working on behalf of the next of kin. This form was created, for the most part, by extracting and reorganizing material from this handbook, therefore it is not reproduced herein. Team members should keep at least one copy on hand at all times to be available should they be called upon to assist a survivor and should refer to this handbook as necessary for preparation details.

• MRSAP Form 3 - THE MILITARY RETIREE SURVIVOR ASSISTANCE PROGRAM (MRSAP) TEAM

This is a list of team members to be used for distribution to those agencies who need to know this information.

• MRSAP Form 4 - DEATH REPORT is completed by the team member and filed with the RAO after all requested assistance to the next of kin has been provided and all necessary agencies (including TROACC, if appropriate) have been notified.

RAO/45 SW & TROACC

MRSAP DEATH REPORT

Information on this page is subject to the provisions of

the Privacy Act of 1947 and will be protected accordingly.

Area # Date of Death:

NAME OF RETIREE:

GRADE OR RANK:

BRANCH OF SERVICE:

SSAN:

PLACE OF DEATH:

FUNERAL HOME:

NEXT OF KIN (NAME) PHONE:

STREET:

CITY: STATE:

WHEN AND HOW INFORMATION RECEIVED:

ASSISTANCE REQUESTED? YES NO DATE:

DATE DEATH REPORTED TO BRANCH OF SERVICE: TROACC MEMBERS: TROACC CO-CHAIR NOTIFIED: DATE: REMARKS:

DATE CASE CLOSED:

SUBMITTED BY: DATE:

_{(MRSAP TEAM MEMBER)}

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

MAIL TO: RAO 45 SPTG/CVR, 620 O'Malley Rd Bldg 537, Patrick AFB, FL 32925-3337

Logged in at RAO: By:

_(Date/Time)

NOTE: MRSAP Team Members must be cognizant of the fact that information on all of these MRSAT forms is subject to the provisions of the Privacy Act of 1947 and must be protected accordingly.

Appendix 2 - USEFUL PUBLICATIONS

NOTE: These publications are available in the Patrick AFB Retiree Activities Office, bldg 722 494-5463 or 494-5464.