OPM uses RI 30-10 to decide whether the adult child of a federal annuitant or deceased employee is incapable of self-support because of a disability that began before age 18, which affects survivor annuity and FEHB family coverage. The physician completes Part B on the back and attaches a narrative on letterhead covering eight points about the condition.
The disabled dependent, a guardian or another fiduciary completes Part A: living situation, any court appointment, employment and earnings in the last 12 months, and education. The dependent's physician completes and signs Part B.
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Disabled Dependent Questionnaire
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A narrative on letterhead addressing eight points: history of the condition, findings from the latest evaluation including tests, current clinical status and treatment plans, whether the condition is static, physical or mental limitations, whether it precludes self-supporting work, the age at which the patient became incapable of self-support, and whether they can handle finances.
The disabled dependent, or their guardian or other fiduciary. Part A covers the dependent's Social Security number, where and with whom they live, any court-appointed guardian, employment and earnings in the past 12 months, and highest education, followed by a certification that authorizes release of medical evidence to OPM.
OPM uses the questionnaire to determine whether an adult child of a federal annuitant or deceased employee remains eligible as a disabled dependent, which bears on a survivor annuity and on family coverage under the Federal Employees Health Benefits program. OPM's Privacy Act statement says the form determines eligibility for continued benefits.