FEDERAL EMPLOYEES GROUP LIFE INSURANCE PROGRAM - CARANCI, JOHN C.

• Document Type: FOIA
• Keywords: PERSONNEL FILES
• Keywords: CARANCI JOHN
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001411660
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 3
• Document Creation Date: June 22, 2015
• Document Release Date: December 31, 2008
• Case Number: F-2007-00327
• Publication Date: November 5, 1970

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See Instructions
..DERAL EMPLOYEES GROUP LIFE INSURArGE PR1I:::ail ~bJ~31
to Agencies on
Reverse Side
1. Name of retired employee
2. Date of birth
Mr. (Last) (First) (Middle)
(Month (Day) (Year)
X44. Caranci John C.
Feb 7 1922
3. Mailing addresjo C( )
4. Plan or system under which retired
CIA Retirement and
Disability System
5. Retirement claim No.
6. Effective date of annuity
7. Did employee retire for
8. Did employee retire on an immediate
(if any)
(Month) (Day) (Year)
disability?
annuity?
May 1 1970
Yes No
Yes ^ No
IF ITEM 7 IS ANSWERED "YES," OMIT ITEMS 9 AND 10.
9. Does employee have 12 or more years' verified creditable service of which at least 5 years are civilian service? Yes ^ No
10. If employee retired on an Immediate annuity but has less than 12 years' verified creditable service and if there is uncertainty as to the creditability
of a period (or periods) of service which is essential to a total of 12 years, list all service of record and any other service alleged by the retired
employee. The Civil Service Commission will verify and/or determine whether the service in question is creditable.
PERIOD OF SERVICE
HAS SERVICE BEEN
DEPARTMENT OR AGENCY
LOCATION OF EMPLOYMENT
TITLE OF POSITION
VERIFIED?
From-
To-
Yes
No
AP
PROVED FOR REL
EASE - CIA INFO^DATE: 1
0-Nov-2008
JC,?N C C RAUCI CSt
11. H the empl Yee 1qd opt on msyrance luring u I
period that such insurance has been available to him? [] Yes No
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u eject s ecmec
t~ona FG
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ur~ye .age.
12. I hereby certify that the above information, excepting period(s) of unverified service alleged by the retired employee, has been obtained from official
records and is correct
~. JUL 973
(Signature of authorized agency official) (Date)
Insurance Officer Alternate
ype name o aus orize agency o cia) (Title)
Central Intelligence Agency Washington, D. C. 20505
(Name of agency) (Mailing address of agency, including ZIP Code)
CERTIFICATION OF CIVIL SERVICE COMMISSION
Individual named above has regular insurance as a retired employee
under the Group Life Insurance Program.
^ Individual named above does not have regular insurance as a retired
employee because:
^ Less than 12 years' creditable service.
^ Not retired on an immediate annuity.
Individual named above has optional insurance as a retired employee
under the Group Life Insurance Program.
individual named above does not have optional insurance as a retired
employee because:
Did not elect optional insurance as an employee.
Not eligible for regular coverage as a retiree.
Not insured from first opportunity.
Insurance coverage at time of termination
Regular
Regular and optional
Standard Form 49
April 1969
U.S. CIVIL SERVICE COMMISSION
FPM SUPPLEMENT 870-1 49-105
 DECEDE T
'ohn C. Caranci
DATE OF
22/ 22
CST 1 255 367
CERTIFICATIO' F IN. -..::NCE STATUS OF DECEASED
ANNUI PANT Oi '~. OMPENSATIONER
FEDERAL EMPLOYEES GROUP LIFE INSURANCE PROGRAM
TO: OFFICE OF FEDERAL EMPLOYEES' GROUP LIFE INSURANCE
This certification is invalid if your records show a conversion after the date insurance coverage as an employee terminated.
A. CERTIFICATION REGARDING DECEASED ANNUITANT
NOTE TO EXAMINER: Certify a deceased compensationer as an insured annuitant if (a) annuity file shows he is otherwise
eligible for insurance as a retired employee and (b) the amount of insurance is the same regardless of annuitant or compensationer
status.
1. (a) TYPE OF RETIREMENT
? DISABILITY
^ NON-DISABILITY
1. (b) DATE OF SEPARATION
12/1667 OR LATER
^ 9/23/59 TO 12/15i07
^ BEFORE 9/23/59 -
The deceased was retired under the Civil Service Retirement System or system
named in attached SF 49, and at time of death:
(3 was insured for regular insurance only.
^ was insured for regular and optional insurance.
^ canceled optional insurance during retirement.
^ on records available to the Commission. SF 56 has been amended to show correct
The deceased's annual pay as shown on SF 56 is consistent with data on records
available to the Commission.
The deceased's annual pay as indicated on SF 56 was not consistent with data
If deceased attained age 65 prior to August 29, 1954, annual pay on August
E] 29, 1954, was $
The deceased was not an insured annuitant at the time of his death (and insurance as a compensationer is not involved
according to our records).
^ His retirement was not based on at least 12 years
creditable service or disability (separation on or
after September 23, 1959).
^ His retirement was not based on at least 15 years
creditable service or disability (separation before
September 23, 1959).
^ His retirement was not on an immediate annuity.
^ He waived insurance coverage as an employee.
^ He was separated before the insurance law went
into effect.
at the time of his death for:
^ Regular insurance only.
^ Regular and optional insurance.
^ Canceled optional insurance during retirement.
^ He retired from employment excluded from insurance
coverage.
^ He converted his insurance after separation for retirement.
^ Other (specify).
^ He died in service after filing for retirement.
^ He died in service without filing for retirement.
^ Other (specify).
I NOTE TO EXAMINER: Verify compensation status with
BEC before completing this certification. `'
The following forms or documents are attached to this certification:
DESIGNATION OF BENEFICIARY - SF 54:
ET- Attached - Rec'd in CSC prior to death.
^ Attached - Rec'd in CSC after date of death from
^ Claimant ^ Agency.
^ No SF 54 on file in CSC.
SF 56 - Agency Certification of Insurance Status.
Death Certificate. [3Attached
^Not on file in CSC.
C3 SF 49- - Certification of Insured Employee's Retired
Status.
^ Other (specify).
(Adjudicator will show any unusual annuity claim circumstances that may affect OFEGLI's payment and enter other pertinent remarks
here. If additional space is needed, use reverse side of this form.)
Please expedite payment of this insurance as soon as possible.
December 23, 1970
ince, and Occupational Health Date
U.S. Civil Service Commission
em 46-49$
AUGUST 1969
 STANDARD FORM 56
AGENCY CERTIFICATION JF INSURANCE STATUS
JANUARY 1970
U.S.. CIVIL SERVICE COMMISSION
e Insurance Program
Li
Group
Group
loyees
Em
Federal
56-109
... .
.
.
.
-
p
.
1. NAME-
2(_a). DATE_OF.BIRTH (Month,.oay,Year) 2(bjn.,? CLAL SECURITY ACCOUNT NUMBER
.Caranci Jodi C.
Feb 7, 1:922 J
3. CHECK THE REASON FOR TERMINATING INSURANCE
(a) Separated (includes resignations) 'r;';
(b) Retired - NOTE: If the reason checked. is'. b, Retired" your group life insurance (but
(c) Died as an employee not accidental death and dismemberment benefits) will continue during retire-
"
(d) 0-Died as a reemployed annuitant - -meet if you meet the conditions described in."Notice to Retiring Employee
(e) Q. End of1 2 months non-pay status below. I
. `_ .. ,. ,
(f) 0Other(specify)
4. CHECK APPROPRIATE BOX CONCERNING SF 54, DESIGNATION OF BENEFICIARY
A CURRENT SF 54 15 A CURRENT SF 54 IS ON FILE IN
(b). ^-- NOT ON FILE WITH THIS (c)- THE EMPLOYEE'S OFFICIAL PERSONNEL
CURRENT (a)'
SF 54 ATTACHED
AGENCY FOLDER (OR EQUIVALENT)
NOTE: IF EMPLOYEE (A) DIED OR (B) IS RETIRING OR RECEIVING FEDERAL EMPLOYEES' COMPENSATION UNDER C15NDITIONS ENTITLING HIM. TO RETAIN HIS LIFE. INSURANCE, ATTACH.
-
BOX 4 (b). IN ALL
4 (a) ON ORIGINAL AND ALL COPIES. OF SF 56; IF NO CURRENT SF 54 IS ON FILE,' CHECK
IF ANY, TO ORIGINAL SF 56 AND CHECK BOX
CURRENT SF 54
,
,
OTHER CASES, SHOW WHETHER OR NOT CURRENT SF 54 IS ON' FILE BY CHECKING BOX- 4 (b) OR (c). A CURRENT SF 54 IS ONE THAT HAS NOT BEEN CANCELED BY EMPLOYEE
OR AUTOMATICALLY BY TRANSFER OR PRIOR TERMINATION OF INSURANCE.
S. DATE OF-WENT CHECKED IN ITEM 3
6. ANNUAL BASIC PAY RATE (NOT. AMOUNT OF INSUR-
HOURLY
CONVERT DAILY
T
M 5
7. DID EMPLOYEE HAVE OPTIONAL INSURANCE ON DATE
IN ITEM 5? NO [R YES 0
8, DATE OF , NOTICE OF CONVERSION
PRIVILEGE (SF 55)
TO EMPLOYEE
(MONTH, OAY, YEAR)
,
,
..
ANCE) ON DATE IN I
E
PIECEWORK, ETC. RATE TO ANNUAL RATE.
IF YES, GIVE RECEIPT DATE OF ELECTION OF OPTIONAL
.
(MONTH, DAY, YEAR)
April 22, 1970
s 14, b84 PER ANNUM
INSURANCE (SF 176 or 176-T):
9, I CERTIFY THAT THE ABOVE INFORMATION HAS BEEN OBTAINED FROM, AND CORRECTLY REFLECTS, OFFICIAL RECORDS AND THAT THE EMPLOYEE
NAMED WAS COVERED BY FEDERAL EMPLOYEES, GROUP LIFE INSURANCE ON. THE DATE SHOWN IN ITEM 5.
Personal si
Name and address of agency, including zip code
Typed nam
title
Phone number, including area co a
Date
AUG
71
170
NOTICE TO RETIRING EMPLOYEE
As a retired employee, your regular life insurance (not accidental death and dismemberment) will be continued without cost to you, provided:
? You do not convert to an individual policy of life insurance; and
? You retire with 12 or more years' creditable service of which at least 5 years are civilian service, or on account of disability; and
? You retire on on immediate annuity.
Your optional life insurance, if you have any (not accidental death and dismemberment), may also be continued, provided:
? You`do not convert it; and
? You continue your regular insurance; and
? You have had optional insurance from the time it-first-became available to you; and-----
? Your monthly annuity is sufficient, after all other deductions, to pay the full cost; and
? You continue to pay the full cost. until you reach age 65 (the cost will be deducted from your monthly annuity check).
Your life insurance as a retired employee will be reduced by. 2% each month beginning at age 65 or at retirement, whichever is later. The maximum
reduction is.75%.. '
You may,-if you' prefer; convert your insurance to on individual life insurance policy in an amount not to exceed your combined regular and optional
insurance. Or you may continue your regular insurance free after retirement, if eligible as described above, and convert only your optional insurance.
Your employing office will instruct you. on the procedure to follow if you want to convert only your optional insurance.
If you are eligible to continue your life.insurance as a.refired employee, your employing agency has been instructed to attach the ORIGINAL of this form
to your application for retirement unless you prefer to'convert your regular insurance to an individual policy:
If you receive the ORIGINAL. copys of this. Certification.. after you file your application for retirement, and you do not want to convert your regular insur-
ance to an, individual-policy, forward the ORIGINAL, as soon as possible to the agency or office which: administers your retirement system.
Keep the DUPLICATE copy for yourself. You will be notified by the Civil Service Commission of your insurance rights,
DEATH; WITHIN 31 DAYS
Under certain conditions, life insurance is payable if death occurs within 31 days after an employee's group insurance terminates, even though the
employee had' not' applied for conversion. If death occurs within this period, further information concerning possible benefits should be obtained from
the agency named in item 9- above.
??...;,- NOTICE. TO EMPLOYEE RECEIVING FEDERAL EMPLOYEES' COMPENSATION
While- you ore receiying monthly benefits under the federal. Employees' Compensation law and are held by the Department of Labor to. be. unable.to
return to duty, your life insurance (not accidental death and dismemberment) may be continued.
Instructions on how you may apply to continue your insurance coverage while receiving Federal employees' compensation are contained an the bock of
PART 1-the ORIGINAL copy of this Certification, which is to be sent to the U. S. Civil Service Commission, Bureau of Retirement, Insurance, and
Occupational Health, Washington, D. C. 20415. Keep the; DUPLICATE copy far yourself.
PART 2-Duplicate SEE OTHER SIDE