Blank OPM Standard form 15 PDF Form

Blank OPM Standard form 15 PDF Form

The OPM Standard Form 15 is a crucial document used by individuals seeking disability benefits from the federal government. This form helps to establish eligibility for various programs and ensures that applicants provide the necessary information for their claims. If you need to fill out this form, click the button below to get started.

The OPM Standard Form 15 plays a crucial role in the federal employment process, particularly for individuals seeking to claim veterans' preference in hiring. This form serves as a vital tool for veterans, enabling them to provide necessary documentation that supports their eligibility for preference points during the hiring process. By filling out this form, veterans can indicate their service history, including dates of active duty and the nature of their discharge. Additionally, the form requires applicants to disclose any relevant awards or decorations received during their military service. It’s essential for veterans to ensure that all information is accurate and complete, as this can significantly impact their chances of securing a federal job. Understanding the nuances of the OPM Standard Form 15 is key for veterans navigating the complexities of the federal employment landscape, allowing them to advocate for their rights and benefits effectively.

Document Sample

 

APPLICATION FOR 10-POINT VETERAN PREFERENCE

 

(TO BE USED BY VETERANS & RELATIVES OF VETERANS)

 

Form Approved:

U.S. Office of Personnel Management

O.M.B. No. 3206-0001

PERSON APPLYING FOR PREFERENCE

1.Name (Last, First, Middle)

2.Home address (Street Number, City, State and ZIP Code)

VETERAN INFORMATION (to be provided by person applying for preference)

3.Veteran's name (Last, First, Middle) exactly as it appears on Service Records

4.Periods of service

Branch of service

Date entered active duty

Date Separated or Released from Active Duty (if applicable)

TYPE OF 10-POINT VETERANS' PREFERENCE CLAIMED

Instructions: Check the block indicating your veterans’ preference claim. Answer any questions associated with a block. The Required Documentation column refers you to information provided on the back of this form regarding the types of documents that are acceptable proof of your claim for preference. (Please note that eligibility for veterans’ preference is governed by 5 U.S.C. 2108, 2108a, and 5 CFR part 211. All conditions are not fully described on this form due to space restrictions.

 

 

 

 

 

 

 

 

 

 

 

 

 

Required Documentation

 

 

 

 

 

 

 

 

 

 

 

 

 

(See reverse of this form.)

 

 

5. Veterans' preference based on non-compensable service-connected disability; award of

-- -- -- -- -- -- -- -- -- -- -- -- -- ---- --

 

 

 

 

the Purple Heart; or receipt of disability pension under public laws administered by the

A and B

 

 

 

Department of Veterans Affairs (DVA).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

Veterans' preference based on a compensable service-connected disability of 10% or

-- -- -- -- -- -- -- -- -- -- -- -- -- ---- --

A and C

 

 

 

 

 

more as determined by the DVA or disability retirement from a Military Service Department.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

No

 

 

 

7. Veterans' preference for a living veteran's spouse based on the fact that the veteran,

a. Are you currently married to the

 

 

 

 

 

veteran? If No, you are not eligible

 

 

 

 

 

 

 

 

 

 

because of a service-connected disability, has been unable to qualify for a Federal

for preference.

 

 

 

 

 

 

C and H

 

 

 

Government job, or any other position.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. Were you married to the veteran at

 

 

 

 

 

 

 

 

 

8. Veterans' preference for a veteran's widow or widower.

the time of death? If No, you are

 

 

 

 

 

 

 

 

not eligible for preference.

 

 

 

 

 

 

A, D, E, and G

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. Have you ever remarried? (Do not

 

 

 

 

 

 

(Submit G when applicable.)

 

 

 

 

 

count annulments.) If Yes, you are

 

 

 

 

 

 

 

 

 

 

 

 

not eligible for preference

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

Veterans' preference for a mother of a veteran who has a service-connected disability

a. Are you married?

 

 

 

 

 

 

Disabled Veteran

 

 

 

that is permanent and totally disabling, or who is deceased provided you are or were

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C, F, and H

 

 

 

married to the veteran's father and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

• your husband is totally and permanently disabled;

b. Are you separated? If Yes, go to

 

 

 

 

 

 

 

 

 

question D.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

• you are widowed, divorced, or separated from the veteran's father and have not remarried;

 

c. Is your husband totally and

 

 

 

 

 

 

Deceased Veteran

 

 

 

 

 

 

 

 

 

 

 

or

permanently disabled?

 

 

 

 

 

A, D, E, and F

 

 

 

 

 

 

 

 

 

 

• you are widowed or divorced from the veteran's father and have remarried, but are now

 

d. Did the veteran die on active duty?

 

 

 

 

 

 

widowed, divorced, or separated from the husband of your remarriage.

If No to C or D, you are not eligible

 

 

 

 

 

 

 

 

 

 

 

 

for preference.

 

 

 

 

 

 

PRIVACY ACT AND PUBLIC BURDEN STATEMENT

The Veterans' Preference Act of 1944 authorizes the collection of this information. The information will be used, along with any accompanying documentation to determine whether you are entitled to 10-point veterans' preference. This information may be disclosed to: (1) the Department of Veterans Affairs, or the appropriate branch of the Armed Forces to verify your claim; (2) a court, or a Federal, State, or local agency for checking on law violations or for other related authorized purposes; (3) a Federal, State, or local government agency, if you are participating in a special employment assistance program; or (4) other Federal, State, or local government agencies, congressional offices, and international organizations for purposes of employment consideration, e.g., if you are on an Office of Personnel Management or other list of eligibles Failure to provide any part of the information may result in a ruling that you are not eligible for 10-point veterans' preference.

Public burden reporting for this collection of information is estimated to take approximately 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to OPM Forms Officer, U.S. Office of Personnel Management, Washington, D.C. 20415; The OMB Number, 3206-0001, is currently valid. OPM may not collect this information and you are not required to respond, unless this number is displayed.

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Page 1 of 2

Clear Form

Standard Form 15 Revised October 2013 All other previous editions are unusable.

DOCUMENTATION REQUIRED - READ CAREFULLY

Please submit photocopies of documents because they will not be returned.

A. Documentation of Service and Separation.

For spouses and mothers of disabled veterans, who checked item 7 or

Any official document or statement from the Armed Forces showing

9, submit the following:

 

 

separation, discharge or release from active duty is under honorable

An official statement, dated 1991 or later, from the Department of

conditions (Honorable or General Discharge). Note: Only the branch of

Veterans Affairs, or from a branch of the Armed Forces, certifying:

service in which the individual served can certify active duty service

the present existence of the veterans service-connected disability;

was performed “Under Honorable Conditions.” Such documents

include, but are not limited to:

the percentage and nature of the service-connected disability or

DD-214, “Certificate of Release or Discharge from Active Duty”

 

disabilities (including the combined percentage); and

Retirement or separation orders

a notation as to whether or not the service-connected disability is

Documents showing transfer to any of the reserve corps of the Armed

 

rated as permanent and total.

 

 

 

Forces

D. Documentation of Veteran's Death

Certification: any written document from the armed forces that certifies

If death occurred while not on active military duty, submit certified

 

the service member is expected to be discharged or released from

 

copy of death certificate.

 

active duty service in the armed forces under honorable conditions not

When a veteran dies on active duty, the family does not receive a DD

 

later than 120 days after the date the certification is signed.

Official statement from military personnel records center

 

Form 214; the family receives a DD Form 1300, Report of Casualty, on

 

which there is no place to record the character of service. Thus, when

B. Documentation of Non-Compensable Service-Connected Disability

 

a veteran dies on active duty, his or her service should be presumed to

 

be under honorable conditions unless the military service specifically

(less than 10%); Purple Heart, and Nonservice-Connected Disability

 

 

indicates otherwise.

Pension. Such documents include, but are not limited to:

 

 

 

An official statement, dated 1991 or later, from the Department of E. Documentation of Service or Death During a War, in a Campaign or

Veterans Affairs or from a branch of the Armed Forces, certifying to the

Expedition for which a Campaign Badge is Authorized, or During

present existence of the veteran's service-connected disability of less

the Period Authorized, or During the Period of April 28, 1952

than 10%.

through July 1, 1955.

• An official citation, document, or discharge certificate, issued by a

Submit documentation of service or death during a war or during the

branch of the Armed Forces, showing the award to the veteran of the

period April 28, 1952, through July 1,1955, or during a campaign or

Purple Heart.

expedition for which a campaign badge is authorized.

•. An official statement, dated 1991 or later, from the Department of

F. Documentation of Deceased or Disabled Veteran's Mother's Claim

Veterans Affairs, certifying that the veteran is receiving a nonservice-

for Preference because of Her Husband's Total and Permanent

connected disability pension.

Disability.

C. Documentation of Compensable Service-Connected Disability

Submit a statement from husband's physician showing the prognosis

(10% or more). Such documents include, but are not limited to:

of his disease and percentage of his disability.

 

An official document, dated 1991 or later, from the Department of

Veterans Affairs, or from a branch of the Armed Forces, certifying that G. Documentation of Annulment of Remarriage by Widow or Widower

 

 

the veteran has a service-connected disability of 10% or more.

of Veteran.

 

 

 

 

 

 

 

 

 

 

 

• An official document or retired orders from a branch of the Armed

Submit either:

 

 

 

 

 

 

 

 

 

 

 

 

Forces, showing that the veteran was retired due to a service-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

connected disability or has been transferred to a Disability Retirement

Certification from the Department of Veterans Affairs that entitlement to

 

 

List with a service-connected disability of at least 10% or more.

 

pension or compensation was restored due to annulment; or

 

 

 

 

 

 

A certified copy of the court decree of annulment.

 

 

 

 

 

 

 

 

 

 

H. Documentation of Veteran's Inability to Work Because of a Service-

 

 

 

 

 

Connected Disability.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer questions 1-7 below:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

Is the veteran currently working? If No, go to Item 3.

2. If currently working, what is the veteran's present occupation?

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

What was the veteran's occupation, if any, before military service?

 

 

 

 

 

4. What was the veteran's military occupation

 

 

 

 

 

 

 

 

 

 

 

at the time of separation?

 

 

 

 

 

 

 

 

 

 

 

 

5.

Has the veteran been employed, or is he/she now employed, by the Federal civil service or D.C. Government?

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Title and Grade of position most recently, or currently, held

B. Name and address of agency

 

 

 

C. Dates of employment

 

 

 

 

 

 

 

 

 

 

 

From:

To:

 

6. Has the veteran resigned from, been disqualified for, or separated from a position in the Federal civil service or D.C. Government

 

 

 

 

 

 

along the lines of his/her usual occupation because of service-connected disability?

 

 

 

 

 

 

 

 

 

Yes

No

 

If Yes, submit documentation of the resignation, disqualification, or separation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. Is the veteran receiving a civil service retirement pension?

 

 

 

Yes

No

 

 

 

 

 

 

 

 

If Yes, give the Civil Service annuity (CSA) or Federal employee retirement annuity number.

 

CSA#

 

 

 

 

 

Standard Form 15

Page 2 of 2Revised October 2013 All other previous editions are unusable.

File Specifics

Fact Name Description
Purpose The OPM Standard Form 15 is used to apply for disability retirement benefits under the Federal Employees Retirement System (FERS) and the Civil Service Retirement System (CSRS).
Eligibility Federal employees who have become disabled and are unable to perform their job duties may apply using this form.
Submission Process Applicants must complete the form and submit it to their agency's human resources office for processing.
Required Documentation Along with the form, applicants need to provide medical documentation supporting their claim of disability.
Governing Laws This form is governed by federal regulations under Title 5 of the U.S. Code, specifically sections related to retirement benefits.
Processing Time The processing time for disability retirement applications can vary, often taking several months to complete.
Impact on Benefits Submitting the form does not guarantee approval; benefits are contingent upon the review of the submitted medical evidence.
Appeals Process If an application is denied, applicants have the right to appeal the decision within a specified timeframe.
Contact Information For questions, applicants can contact the Office of Personnel Management or their agency's human resources department for assistance.

How to Use OPM Standard form 15

Filling out the OPM Standard Form 15 is an important step in the application process for certain benefits. To ensure accuracy and completeness, follow these steps carefully.

  1. Start by downloading the OPM Standard Form 15 from the official website or obtain a physical copy.
  2. Read the instructions provided on the form to understand the requirements.
  3. In the first section, enter your personal information, including your full name, address, and contact details.
  4. Provide your Social Security number in the designated field.
  5. Fill out the section regarding your employment history, including the names of employers, dates of employment, and job titles.
  6. Complete the section that asks about your disability status, providing any necessary documentation or details.
  7. Review the information you've entered to ensure it is accurate and complete.
  8. Sign and date the form at the bottom as required.
  9. Make a copy of the completed form for your records.
  10. Submit the form according to the instructions provided, either by mail or electronically, as appropriate.

Your Questions, Answered

What is the OPM Standard Form 15?

The OPM Standard Form 15 is a document used to apply for a disability preference in federal employment. This form is essential for individuals who are claiming a 10-point veteran's preference based on a service-connected disability. It serves as a way for veterans to demonstrate their eligibility for certain hiring advantages within the federal government.

Who is eligible to use Form 15?

Eligibility for using Form 15 primarily includes veterans who have a service-connected disability rated at 10% or more. This form is also available to certain family members of veterans who are entitled to preference. It's important to review the specific criteria outlined by the U.S. Office of Personnel Management (OPM) to ensure eligibility.

How do I obtain Form 15?

Form 15 can be obtained directly from the OPM website or through various federal agency human resources offices. The form is available for download in PDF format, making it easy to print and fill out. Additionally, physical copies may be available at local veteran service organizations.

What information is required on Form 15?

Form 15 requires several key pieces of information, including:

  • Your personal information (name, address, contact details)
  • Your military service details (branch, dates of service)
  • The nature and extent of your disability
  • Supporting documentation to verify your disability status

Completing the form accurately is crucial for ensuring that your application is processed without delays.

How should I submit Form 15?

Once completed, Form 15 can be submitted via mail or electronically, depending on the instructions provided by the agency you are applying to. It’s advisable to check the specific submission guidelines for the agency to which you are applying, as these can vary.

What happens after I submit Form 15?

After submission, your application will be reviewed by the appropriate agency. You may receive a notification confirming receipt of your form. The review process can take some time, so it’s important to be patient. If additional information is needed, the agency will reach out to you directly.

Can I appeal if my request for preference is denied?

Yes, if your request for disability preference is denied, you have the right to appeal the decision. The appeal process typically involves submitting a written request for reconsideration, along with any additional supporting documentation. Be sure to follow the specific instructions provided in the denial notice for the best chance of a successful appeal.

Where can I find additional resources about Form 15?

Additional resources regarding Form 15 can be found on the OPM website, as well as through veteran service organizations and local employment offices. These resources often provide guidance on completing the form and navigating the federal hiring process.

Common mistakes

  1. Failing to provide complete personal information. Ensure that your name, address, and contact details are accurate and up to date.

  2. Not checking for signature requirements. Some sections may need a signature, and missing this can delay processing.

  3. Overlooking the deadline for submission. Submitting the form late can result in denial of benefits.

  4. Providing insufficient medical documentation. Ensure that all required medical evidence is included to support your claim.

  5. Ignoring instructions for specific sections. Each part of the form has unique requirements; read the instructions carefully.

  6. Not using the correct form version. Always check that you are using the most recent version of the OPM Standard Form 15.

  7. Failing to review for errors. Typos and inaccuracies can lead to unnecessary complications.

  8. Submitting without a copy for personal records. Keep a copy of your completed form for your own reference.

  9. Neglecting to follow up on the status of the application. It’s important to check in to ensure your submission was received and is being processed.

  10. Relying solely on online resources for guidance. While helpful, always refer to the official OPM website or contact them for specific questions.

Documents used along the form

The OPM Standard Form 15 is crucial for individuals seeking disability retirement benefits. However, several other forms and documents often accompany it to ensure a complete application. Below is a list of these essential documents, each serving a specific purpose in the application process.

  • OPM Standard Form 2801: This form is used to apply for retirement benefits under the Federal Employees Retirement System (FERS) or the Civil Service Retirement System (CSRS). It gathers essential information about the applicant's employment history and service record.
  • OPM Standard Form 3107: This form is specifically for applying for disability retirement benefits under FERS. It requires details about the applicant's medical condition and how it affects their ability to work.
  • Medical Documentation: Comprehensive medical records from healthcare providers are necessary to substantiate the claim. This documentation should detail the diagnosis, treatment, and prognosis of the applicant's condition.
  • OPM Standard Form 404: This form is used to provide additional information about the applicant's employment and disability status. It helps clarify any discrepancies in the application.
  • Personal Statement: A narrative from the applicant explaining their medical condition, how it impacts their daily life, and their work history can provide valuable context to the application.
  • Employer's Statement: A letter or form from the applicant's employer detailing their job responsibilities, performance, and any accommodations made due to the applicant's medical condition is often required.
  • OPM Standard Form 15-A: This is an optional form that allows applicants to provide additional information about their disability. It can help strengthen the case for benefits.
  • Social Security Administration (SSA) Documentation: If the applicant is also applying for Social Security disability benefits, relevant SSA documents may be needed to support the claim.
  • Release of Information Authorization: This form grants permission for healthcare providers to share medical information with the OPM, ensuring a smoother review process.

Each of these documents plays a vital role in the application for disability retirement benefits. Submitting a complete and thorough application increases the chances of approval and ensures that all necessary information is available for review.

Similar forms

The OPM Standard Form 15 (SF-15) is similar to the Department of Veterans Affairs (VA) Form 21-526EZ, which is used for disability compensation claims. Both forms serve to establish eligibility for benefits based on service-related conditions. The VA Form 21-526EZ requires veterans to provide information about their military service and any disabilities they are claiming, while the SF-15 focuses on veterans’ preference in federal employment. Each form requires documentation to support the claims being made, ensuring that applicants provide sufficient evidence for their requests.

Another document comparable to the SF-15 is the Equal Employment Opportunity Commission (EEOC) Form 5, which is used for filing a charge of discrimination. Like the SF-15, the EEOC Form 5 is designed to protect rights and ensure fair treatment. Both forms require detailed information about the individual’s situation, including any relevant dates and circumstances. The SF-15 specifically addresses veterans' preference, while the EEOC Form 5 focuses on discrimination in the workplace, but both aim to uphold individuals' rights in employment settings.

The Federal Employment Opportunity Commission (FEOC) Form 462 is also similar to the SF-15 in that it addresses employment opportunities for veterans. This form is used to collect data on the employment of veterans in federal agencies. Both documents emphasize the importance of veterans' status in federal employment and require similar supporting documentation to demonstrate eligibility. The SF-15 is specifically for claiming veterans’ preference, while the FEOC Form 462 is more about reporting and analyzing employment practices regarding veterans.

Additionally, the U.S. Office of Personnel Management (OPM) Form 1203-FX is relevant as it is used for applying to federal jobs. This form allows applicants to claim various preferences, including veterans' preference. Similar to the SF-15, the 1203-FX requires applicants to provide detailed information about their qualifications and any supporting documentation. Both forms aim to ensure that veterans receive appropriate consideration in the hiring process, reinforcing their rights and benefits as former service members.

Lastly, the SF-50, Notification of Personnel Action, can also be seen as similar to the SF-15. The SF-50 is used to document employment actions for federal employees, including veterans. While the SF-15 is focused on applying for veterans' preference, the SF-50 records the employment status and rights of veterans once they are in the federal workforce. Both documents are essential in maintaining accurate records and ensuring that veterans receive the benefits and considerations they are entitled to within federal employment.

Dos and Don'ts

When filling out the OPM Standard Form 15, it is important to approach the process with care and attention to detail. Below is a list of things you should and shouldn't do to ensure your application is completed correctly.

Things You Should Do:

  • Read the instructions carefully before starting the form.
  • Provide accurate and complete information in all sections.
  • Use black ink or type the information to ensure clarity.
  • Double-check your entries for any spelling or numerical errors.
  • Sign and date the form where required.
  • Keep a copy of the completed form for your records.
  • Submit the form by the deadline to avoid any processing delays.

Things You Shouldn't Do:

  • Do not leave any sections blank; if a section does not apply, indicate that clearly.
  • Avoid using white-out or erasing mistakes; instead, cross out errors neatly and write the correct information.
  • Do not provide false or misleading information, as this can lead to serious consequences.
  • Refrain from submitting the form without reviewing it thoroughly.
  • Do not forget to include any required supporting documents.
  • Do not assume your application is complete without checking all requirements.
  • Do not submit the form via an untraceable method; use a reliable mailing service.

Misconceptions

Understanding the OPM Standard Form 15 can be challenging due to several misconceptions. Here are some common misunderstandings explained:

  • Misconception 1: The form is only for federal employees.
  • This form is actually designed for individuals seeking federal employment benefits, not just current federal employees. Anyone applying for certain benefits can use it.

  • Misconception 2: You must have a disability to use the form.
  • While the form is often associated with disability claims, it can also be used for other qualifying conditions. It’s important to review eligibility criteria carefully.

  • Misconception 3: Submitting the form guarantees benefits.
  • Filling out the form does not automatically ensure that you will receive benefits. Each application is reviewed on a case-by-case basis.

  • Misconception 4: The form is too complicated to complete.
  • Many people find the form straightforward. Clear instructions are provided, and assistance is available if needed.

  • Misconception 5: You cannot appeal if your application is denied.
  • You do have the right to appeal a denial. There are established procedures to follow if you believe your application was unjustly rejected.

  • Misconception 6: The form is only relevant for certain age groups.
  • The OPM Standard Form 15 is applicable to individuals of all ages, as long as they meet the necessary qualifications for benefits.

Addressing these misconceptions can help individuals navigate the process more effectively. Understanding the facts can lead to better outcomes when applying for benefits.

Key takeaways

When filling out and using the OPM Standard Form 15, keep these key takeaways in mind:

  1. Understand the Purpose: This form is used to apply for disability retirement under the Federal Employees Retirement System (FERS) or the Civil Service Retirement System (CSRS).
  2. Provide Accurate Information: Ensure all personal and employment details are correct. Inaccuracies can delay processing.
  3. Include Supporting Documentation: Attach all necessary medical records and other relevant documents to support your claim.
  4. Follow Submission Guidelines: Submit the form according to the instructions provided. This includes using the correct mailing address and format.
  5. Keep Copies: Retain copies of the completed form and any documents submitted for your records.