OPM uses this report when a retiring Civil Service Retirement System employee elects a reduced annuity to provide a survivor benefit for someone with an insurable interest in them. The treating physician performs a routine general medical examination and reports whether the applicant is in good physical condition. OPM uses the findings to decide whether the election can be allowed.
The applicant completes items 1 to 4, including whether they know of any condition that could shorten life expectancy, and signs item 5 in the physician's presence. The treating physician records 20 exam items, from general appearance and blood pressure to the nervous system and a conclusion, and signs with the exam date.
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Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System
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Only when a retiring CSRS employee elects a reduced annuity to provide a survivor benefit for a person with an insurable interest in them. OPM uses the exam to decide whether the employee may make that election. It is not used for FERS retirements or for ordinary spousal survivor elections.
A routine general medical examination. The physician records general appearance and nutrition, height, weight, blood pressure, skin, gait, eyes, ears, nose, mouth, neck, heart, lungs, abdomen, extremities, reflexes and nervous system, then notes any significant impairment and writes a conclusion on the applicant's physical condition.