Note:This form is used to report a missing retirement payment for a retiree or survivor annuitant who is currently receiving a monthly annuity benefit payment under the District of Columbia Police Officers', Firefighters', and Teachers' Retirement Plans (the Plan or Plans). The missing payment can be reported by the retiree, survivor, or by a relative/friend/representative.  Missing payments should be reported immediately. 

This form is not for missing refunds or lump sum payments. If you need further assistance or need to report a missing refund or lump sum payment, 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.