Federal Government Programs (FGP)
 Overseas Claim Submission

ATTENTION: A claim form must be completed before attaching it to this submission form. A claim form can be obtained by clicking the link Claim form.

Required Information

 /   /  MM/DD/YYYY
(9-digit number without hyphens or spaces)

Required File Attachments

All claims submitted via this form MUST include a scanned image file of your dentist's payment receipt along with your completed Federal Employees Dental Program claim form. Accepted image file types are pdf, jpg, jpeg, tif and tiff.


Additional Information

Enter any additional related information that may be helpful in processing your claim:

Security Question

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