SURVIVOR BENEFIT PROGRAM OFFSET IMPACT EXAMPLE
Return to:
MOAA
Attn: Col Lee Lange, USMC (Ret)
201 North Washington Street
Alexandria, VA 22314-2539
NAME:________________________________________________________________________________
STREET ADDRESS:___________________________________________________________________
CITY:_______________________________________ STATE:_________ ZIP CODE:______________
AGE:_________ YEAR YOU BECAME A WIDOW OR WIDOWER:_____________
SPOUSE'S SERVICE (ARMY, NAVY, ETC.):_______________________________________________
TELEPHONE (HOME)__________________________________________________________________
E-MAIL ADDRESS:____________________________________________________________________
DID YOU KNOW ABOUT THE SBP AGE 62 OFFSET/BENEFIT REDUCTION PROVISION AT AGE
62 WHEN YOUR SPOUSE ENROLLED IN THE SBP PROGRAM? YES______ NO______
WHAT WAS THE MONTHLY AMOUNT OF YOUR OFFSET AT AGE 62? (YOU DO NOT HAVE TO
ANSWER THIS QUESTION IF YOU ARE NOT COMFORTABLE DOING SO): $_________________
IMPACT THAT THE SBP OFFSET BENEFIT/REDUCTION HAS HAD ON YOU (SUCH AS CHANGE IN LIFESTYLE, ETC.):
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(YOU MAY CONTINUE ON THE BACK OF THIS PAGE)
I AM WILLING TO TALK WITH A NEWSPAPER OR BROADCAST REPORTER ABOUT MY
EXPERIENCES WITH THE SURVIVOR BENEFIT PROGRAM AND THE IMPACT ANY OFFSET HAS
HAD ON MY LIFE: (PLEASE CHECK ONE)
YES________ N0__________
IF YOU ARE WILLING TO TALK WITH A MEMBER OF THE NEWS MEDIA, DO YOU WANT
MOAA TO CALL YOU FIRST BEFORE GIVING YOUR NUMBER OUT TO REPORTER? (PLEASE
CHECK ONE)
CALL ME FIRST_________ DON'T NEED TO CALL ME FIRST____________
SIGNATURE_________________________________________________
CONTINUATION OF IMPACT NARRATIVE (IF NEEDED): _________________________________
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