CLER for NFC

Last Name*

Required, alphanumeric, 25 positions

Enter the last name of the person who is enrolled in FEHB and whose FEHB coverage will cover the family member who is suspending his/her own FEHB coverage. If the enrollee who is providing the coverage has a title (e.g., Jr, Sr, I, II, III), it should be entered after the last name without punctuation (e.g., Smith Jr or Smith III).

Note: If the radio button next to "Will be Covered Under the Enrollment of" is selected, this field must be completed; otherwise, do not complete this field.