
ITEM 18. Enter the number of exemptions claimed.
ITEM 19. Enter the dollar amount of additional Federal income tax you desire
withheld from each month's pay. Leave blank if you do not desire additional
withholding.
ITEM 20. Enter the word "EXEMPT" in this item only if you meet all the
following criteria: (1) you had no Federal income tax liability in the prior year;
(2) you anticipate no Federal income tax liability this year; and (3) you therefore
desire no Federal income tax to be withheld from your retired/retainer pay.
NOTE: You must file a new exemption claim form with DFAS - Cleveland by
February 15th of each year for which you claim exemption from withholding.
ITEM 21. If you are not a U.S. citizen, provide, on an additional sheet, a list of
all periods of ACTIVE DUTY served in the continental U.S., Alaska, and
Hawaii. Indicate periods of service by year and month only. List only service at
shore activities; do not report service aboard a ship.
For example:
FROM (Year/Month) DUTY STATION TO (Year/Month)
1994/02 NAVSTA, Norfolk, VA 1995/01
NOTE: This information may affect the portion of retired/retainer pay which is
taxable in accordance with the Internal Revenue Code if you maintain a
permanent residence outside the U.S., Alaska, or Hawaii.
SECTION VII - VOLUNTARY STATE TAX WITHHOLDING.
Complete this section only if you want monthly state tax withholding. If you
choose not to have a monthly deduction, you remain liable for state taxes, if
applicable.
ITEM 22. Enter the name of the state for which you desire state tax withheld.
ITEM 23. Enter the dollar amount you want deducted from your monthly retired/
retainer pay. This amount must not be less than $10.00 and in whole dollars
(Example: $50.00, not $50.25).
ITEM 24. Enter only if different from the address in Item 9.
PART II - LUMP SUM ELECTION.
OPTIONAL. Only complete Part II if you are:
• Covered under the Blended Retirement System; AND,
• Want to elect a partial lump sum of retired pay
If you are not covered under the Blended Retirement System or do NOT want
to elect a partial lump sum, proceed to PART III of the form.
SECTION VIII - BLENDED RETIREMENT SYSTEM LUMP SUM ELECTION.
ITEM 25. Indicate in Item 25.a OR 25.b whether you intend to receive a 25
percent or 50 percent lump sum of retired pay.
ITEM 26. If indicating in Item 25.a or 25.b that you desire to receive a lump
sum of retired pay, indicate in 26.a through 26.d whether you would like that in
one payment or a series of equal, annual installments over 2, 3, or 4 years.
ITEM 27. Before signing in Item 28, you must read the considerations listed in
Item 27. You are highly encouraged to review your options with a financial
professional and compare your estimated retirement benefits with or without a
lump sum using the online calculator located at
http://militarypay.defense.gov/calculators/BRS.
ITEM 28. If you mark Items 25 and Items 26, you must sign in the block at
28.a, and indicate the date you are signing in 28.b. The date in 28.b must be
at least 90 days prior to the date of your retirement or the date you transfer to
the Fleet Reserve (shown in Item 4, this is also the same date indicated on
your DD 108 request for retirement). If you are a Reserve/National Guard
member qualified to receive retired pay with a non-regular retirement, the date
in 28.b must be 90 days prior to the date upon which you will be eligible to
begin receiving retired pay (shown in Item 4, this is also the same date
indicated on your DD 108 request for retirement).
If you are NOT electing a lump sum of retired pay, DO NOT SIGN Item 28.
PART III - SURVIVOR BENEFIT PLAN.
It is very important that you are counseled and are fully aware of your options
under the Survivor Benefit Plan (SBP). SBP pays your eligible beneficiary or
beneficiaries an inflation-protected annuity, based on your retired pay, in the
event of your death. The cost of SBP is subsidized by the government, but you
will be required to pay a portion of the cost of SBP through deductions from
your retired pay. All retiring active duty members and all members of the
Reserves / National Guard who complete 20 qualifying years of service are
automatically fully covered under the SBP or the Reserve Component SBP
(RC-SBP) unless electing to reduce or decline this coverage. There are
special requirements for reducing or declining coverage that are covered in
Part III.
SECTION IX - DEPENDENCY INFORMATION.
ITEM 29. Provide your spouse's name, SSN, and date of birth. If no current
spouse, enter "N/A" and proceed to Item 32.
ITEMS 30 and 31. Enter the date and location of your marriage to your current
spouse. In Item 30, if marriage occurred outside the United States, include city,
province, and name of country.
ITEM 32. If you do not have dependent children, enter "N/A" in this item. If you
do have dependent children, provide the requested information. Designate
which children resulted from marriage to a former spouse, if any, by indicating
(FS) after the relationship in Item 32.d.
ITEM 32.e. Enter YES or NO as appropriate. A disabled child is an unmarried
child who meets one of the following conditions: a child who has become
incapable of self-support before the age of 18, or, a child who has become
incapable of self-support after the age of 18 but before age 22 while a full-time
student. If answering yes, attach documentation.
SECTION X - SURVIVOR BENEFIT PLAN (SBP) ELECTION.
In this section, you will be able to indicate your desired SBP election and
designate the beneficiary for SBP in the event of your death. If you make no
election, you will automatically receive maximum coverage for all eligible family
members (spouse and/or children). If you elect to reduce or decline your
coverage, your spouse will have to concur with that decision. You may
discontinue your SBP participation within one year after the second
anniversary of the commencement of retired/retainer pay. Termination of SBP
is effective the first of the month after DFAS-Cleveland receives the SBP
disenrollment request. There will be no refund of SBP costs paid for the period
before the SBP disenrollment. You are advised to consult with a SBP
Counselor or Retirement Services Officer prior to completing this section.
ITEM 33. RESERVE COMPONENT ONLY. Information to complete this
section can be found on the DD Form 2656-5 you submitted when you were
first notified that you had completed 20 years of creditable service, known as
your “Notification of Eligibility.” Reserve or National Guard members who
previously completed 20 qualifying years of service are automatically covered
under the RC-SBP unless electing, within 90 days of receiving their Notification
of Eligibility, to decline this coverage. Indicate in Item 33.a., 33.b., or 33.c. your
previous election. If you elected immediate coverage (Item 33.c, or “Option
C”), elected coverage to begin at age 60 (Item 33.b, or “Option B”) or made no
election previously, this remains your coverage and cannot be changed.
However, Reserve/National Guard members who declined to make an election
until reaching the age of eligibility to receive retired pay (Item 33.a, or “Option
A”), or who were unmarried and had no eligible children at initial RC-SBP
election and made no subsequent RC-SBP election must complete Items 34
and 35 (and Items 36 through 38 if applicable). If you elected either Immediate
(Option C) or Deferred (Option B) RC-SBP coverage and the elected
beneficiary is no longer eligible, provide supporting documentation with this
form.
ITEM 34. Enter your desired coverage in Items 34.a through 34.g. You may
only select one item. If you elect 34.a, 34.c, or 34.g, you MUST also indicate
whether you are declining coverage for other eligible dependents.
DD FORM 2656 INSTRUCTIONS, OCT 2018
Page 2 of 3
PREVIOUS EDITION IS OBSOLETE.
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