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): 0001411662
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 2
• Document Creation Date: June 22, 2015
• Document Release Date: December 31, 2008
• Case Number: F-2007-00327
• Publication Date: August 17, 1970

See Instructions
:DERAL EMPLOYEES GROUP LIFE INSURANCE PRO.
to Agencies on
Reverse Side
1. Name of retired employee
2. Date of birth [b1[61
Mr. (Last) (First) (Middle)
(Month) (Day) (Yea
[b][31
Caranci John C.
Feb 7 1922
3. Mailing addre (
4. Plan or system under which retired
c 14C
!
CIA Retirement and
L
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)
T
(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? E] Yes E 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.
HAS SERVICE BEEN
PERIOD OF SERVICE
DEPARTMENT OR AGENCY
LOCATION OF EMPLOYMENT
TITLE OF POSITION
VERIFIED'?
From-
To-
Yes
No
APPROVED FOR RELEASE^DATE
:
10
No
2008
-
v-
t~ 1 C
JOH N C C
~ t~
RANC I CSI -
5 -4
2, ,5 .i'?: i
C o
11. H the empl yee i)d opt'on ins ranee urn th full eriod that such insurance has been available to him? Yes No
Sut ject c~ecl~.nec t ana 'sE6LlpcOV&-rage.
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 (b 3 1 JUL 1970
(Signature of authorized agency official) (Date)
Insurance Officer Alternate
(Title)
Central Intelligence Agency Washington, D. C. 20505
(Name of agency) (Mailing address of agency, including ZIP Code)
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.
J r? 5 It;' l
14 Id1Y 1970
^ Individual named above has optional insurance as a retired employee
under the Group Life Insurance Program.
ndividual 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
IA-170
(Date)
Standard Form 49
April 1969
U.S. CIVIL SERVICE COMMISSION
FPM SUPPLEMENT 870-1 49-105
 INSTRUCTIONS TO AGENCY OR OFFICE ADMINISTERING THE RETIREMENT SYSTEM
DEFINITIONS.-"Retirement for Disability," referred to in Item 7, means retirement under a provision of
your system which requires a finding of "disability" as a prerequisite for title to annuity. (An employee
who meets age and service requirements only is not "retired for disability". even though ill health forced
his separation for retirement.)
"Immediate annuity," referred to in Items 8 and 10, means one which begins to accrue not later than
1 month following the date that the insurance would otherwise terminate. (This date is shown in Item 5
of the Agency Certification of Insurance Status (SF, 56), submitted to you by the retiring employee.)
''Verified creditable service," referred to in Items 9 and 10, means service for the Federal or District of
Columbia Governments which is allowable under section 8332 of title 5 United States Code, and which
is substantiated by official records in your agency. The 12 years' creditable service may include periods
of honorable active service in the Army, Navy, Air Force, Marine Corps, or Coast Guard of the United States
provided at least 5 of the 12 years are civilian service.
COMPLETION OF CERTIFICATION.-Prepare this certification in triplicate for each insured employee who has
retired under any Federal system other than the Civil Service Retirement System who submits a completed
Agency Certification of Insurance Status (SF 56).
DISPOSITION OF CERTIFICATION.-Send the original and duplicate. of this certification together with Stand-
ard Form 56 to the U.S. Civil Service Commission, Bureau of Retirement, Insurance, and Occupational
Health, Washington, D.C. 20415. Retain copy in your file. The duplicate will be returned for your records
indicating whether the retired employee is insured.
CANCELLATION OF OPTIONAL INSURANCE.-An annuitant under age 65 desiring to cancel his optional
insurance should be instructed to submit.an SF 176 declining' (canceling), the optional insurance to his
retirement system so that deductions can be stopped. The retirement system will send the original of the
form to the Civil Service Commission and retain the duplicate.
REPORTING TERMINATIONS OF ANNUITY.-Upon death of an insured retired employee or upon termination
of his annuity for other causes under conditions which divest him of title thereto, complete the appropriate
box on duplicate of certification and send it to the U.S. Civil Service Commission, Bureau of Retirement,
Insurance, and Occupational Health, Washington, D.C. 20415. If you are in contact with the family.of a de-
ceased annuitant and can obtain a completed claim for death benefits (Form FE-6), it should be sent to
the Civil Service Commission together with the duplicate of the certification and other documents to, support
the claim.