COAP CHECKLIST (Federal Government Plans)

 

Please fill out the checklist below and then submit for our review.

Alternatively, you can download the checklist here and corresponding release form here and then fax, email or mail, along with the applicable documents.

Fax: (281) 528-6113
Email: richardj@qdrosvc.com
Mail:
QDRO Services, L.L.C.
P.O. Box 1569
Spring, Texas 77383-1569

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Note: The use of the internet for communications with the firm will not establish an attorney-client relationship and messages containing confidential or time-sensitive information should not be sent.

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Instructions:
* (asterisk) indicates required fields.

Employee information:

Name: *

Email: *

Retired:

Yes No

Address: *

City: *

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip: *

Social Security Number:

Date of birth: mm/dd/yyyy

Former Spouse information:

Name:

Address:

City:

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Social Security Number:

Date of birth: mm/dd/yyyy

Date of marriage: mm/dd/yyyy

Date of divorce: mm/dd/yyyy

Federal Government Service Information:

Agency of the Federal Government:

Date of employment: mm/dd/yyyy

Date of retirement: mm/dd/yyyy

Prior Military Service:

Branch of Service:

a. U.S. Army. b. U.S. Air Force c. U.S. Navy d. U.S. Coast Guard e. U.S. Marines

Date of enlistment: mm/dd/yyyy

Date of separation: mm/dd/yyyy

Please provide the indicated exhibits:*

1. Copy of any pleading with style of case, case number, attorneys’ names, addresses, phone, fax and State Bar numbers. 2. Copy of decree, judgment, agreement, Rule11, etc. as to all benefits. 3. Copy of latest statement of estimated benefits. Very Important * 4. Please draft COAP. Fee $
Payable with request.

SPECIAL INSTRUCTIONS OR REQUESTS:

Attorney / Mediator: *

Transmit correspondence by e-mail to the following mailbox: *

NOTE: Fees are payable in advance prior to commencement of work.

* The employing agency is the proper source for employment and pay information about a current employee’s service with that agency. However, if a current employee has previous employment with a different Federal agency, information about the employee’s contributions during to the Retirement Fund during the prior service is available from OPM at the following address:

Associate Director for Retirement and Insurance
U. S. Office of Personnel Management
P. O. Box 16
Washington, DC 20044-0016

Please include the name, address, date of birth and Social Security Number of all children.