5 CFR §839.1206

1. (a)No specific form is required. Your request must be in writing and contain the following information:
   1. (1)It must describe the basis for the claim and state the dollar amount you seek to receive;
   2. (2)It must include your name, address, and telephone number;
   3. (3)It must include the name, address, and telephone number of your current or last employer;
   4. (4)It must be signed by you; and
   5. (5)It must include any information you believe OPM should consider, such as cancelled checks or other evidence of amounts you paid.
2. (b)Send your claim to: Office of Personnel Management, Retirement and Insurance Service, ATTN: FC Section, Washington, DC 20415-3200