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Get OPM SF 3109 1989-2024

Cording to your employing office's instructions. Section 2. Identifying Information (type or print) Name (Last, first, middle) Date of birth (mo, dy, yr) Social Security Number Employing Department or Agency Agency location (City, state, ZIP Code) Section 3. Verification of Receipt of Election Form (Employee's signature in this section verifies receipt of this form. It does not constitute an election.) Employee's signature Date Office telephone number After signing, return Part 1 acco.

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