Form Information
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FORM NUMBER: DD2656-11

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TITLE: STATEMENT CERTIFYING NUMBER OF MONTHS OF SURVIVOR BENEFIT PLAN (SBP) PREMIUMS PAID

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EDITION DATE: 20090401 CANCELLATION DATE: 20090630

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AVAILABLE FILE FORMATS: PLEASE NOTE:
Fillable Adobe: If no hyperlink appears next to a format, the form is not available electronically.
Perform Pro: To obtain hard copies of current forms not available in electronic format, please
Form Flow 2.0: contact your own Military Service or DoD Component Forms Management
Form Flow 99: Officer. Cancelled forms are not available in electronic formats. Click on link for
Other: a list of Forms Management POCs.

Forms Management POCs

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REMARKS: PROGRAM AND FORM EXPIRED ON JUNE 30, 2009
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ISSUANCES: 10 USC, CHAPTER 73
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SPONSOR / POC: P&R SUB-SPONSOR: MPP/COMP
NUMBER OF PAGES: 2
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USERS*: DFAS
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PRESCRIBED OR ADOPTED?: P

DISPOSITION: S

FUNCTION CODE: 1341

FORM CONTROLLED: N

MANDATORY PRINT SPECIFICATIONS: N

RCS:

IRCN:

OMB:

PRIVACY ACT IMPLICATIONS: Y
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* All revisions and/or cancellations must be coordinated through these USERS.

DISPOSITION: S = Do NOT use previous edition. U = Use previous edition until supply is depleted.