Please complete this form if you are a child survivor of a deceased police officer or firefighter member who wishes to make a change of status. Once you have completed the form, submit it to the DCRB Member Services Center. The original form must be mailed to DCRB.

Please Note: In accordance with D.C. Code §5-701 (5), to remain eligible to receive benefits as a child survivor, you must be unmarried, between the ages of 18 and 22, and a student pursuing a full-time course of study in an accredited educational institution, or you must be unmarried, regardless of age, and incapable of self-support due to a mental or physical disability incurred before the age of 18.

You can send the completed form and any required attachments by mail to:

DC Retirement Board
Member Services Center
900 7th Street, NW, Second Floor
Washington, DC 20001

If you have further questions, please contact the DCRB Member Services Center by clicking on the Ask Member Services link, or by phone at (202) 343-3272 Monday – Friday from 8:30 am to 5:00 pm.