Designating DHS as the PRB - Designation Process - Page 8a
DHS-5037
The purpose of the DHS-5037 is to notify the annuity issuer that the owner(s) of the annuity listed are requesting to designate DHS as the PRB. The form provides instructions for the issuer and indicates the issuer’s responsibilities as well as DHS responsibilities.
Before you send the DHS-5037, you must enter:
- The date in the date box found at the top of page 1.
- The annuity issuer and annuity owner information in the main box found on page 1.
- Your name and county address in the “County Address” box found on page 2.
The annuity issuer must:
- Begin the process of designating DHS as the PRB.
- Complete the “Confirmation/Status of Request to Name DHS Beneficiary of Annuity” section found on page 2 and sign the form.
- Return the form in 30 days from the date of the notice.
