OMB
.report
Search
Sf 2812
Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement
OMB: 3206-0262
IC ID: 209209
OMB.report
OPM
OMB 3206-0262
ICR 201305-3206-001
IC 209209
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0262 can be found here:
2018-10-19 - Reinstatement without change of a previously approved collection
Documents and Forms
Document Name
Document Type
Form SF 2812
SF 2812
Form and Instruction
SF 2812 Report of Withholdings and Contributions for Health Bene
sf2812.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
SF 2812
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
SF 2812
Report of Withholdings and Contributions for Health Benefits, Life Insurance, and Retirement
sf2812.pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Central Personnel
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
Number of Respondents for Small Entity:
0
Affected Public:
Federal Government
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2,600
0
2,600
0
0
0
Annual IC Time Burden (Hours)
1,300
0
1,300
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.