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Get OPM SF 2810 1995-2024

Te of birth 3. Social security number 4. Home address (including ZIP Code) 5. Payroll office number 6. Enrollment code number 7. SF 2811 Report number 8. Date this action becomes effective Only the item that is checked below affects your enrollment. Read that item carefully and follow any pertinent instructions. Keep this form for your records. Part B - Termination Your enrollment terminates on the date in Part A, item 8, above. However, your coverage is extended for 31 days after t.

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