Life Insurance Election

ICR 202203-3206-007

OMB: 3206-0230

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Unchanged
Justification for No Material/Nonsubstantive Change
2022-03-07
Supplementary Document
2021-07-13
Supplementary Document
2021-07-13
Supplementary Document
2018-03-12
Supplementary Document
2018-03-12
Supplementary Document
2018-03-12
Supporting Statement A
2021-07-13
IC Document Collections
IC ID
Document
Title
Status
33739 Unchanged
ICR Details
3206-0230 202203-3206-007
Received in OIRA 202107-3206-001
OPM SF 2817
Life Insurance Election
No material or nonsubstantive change to a currently approved collection   No
Regular 03/07/2022
  Requested Previously Approved
09/30/2024 09/30/2024
150 150
38 38
1,009 1,009

Standard Form 2817, Life Insurance Election, is used by Federal employees and assignees (those who have acquired control of an employee/annuitant's coverage through an assignment or ''transfer'' of the ownership of the life insurance).

US Code: 5 USC Chapter 87 Name of Law: Life Insurance
  
None

Not associated with rulemaking

  86 FR 11340 02/24/2021
86 FR 36589 07/12/2021
No

1
IC Title Form No. Form Name
Life Insurance Election SF 2817, SF 2817 Life Insurance Election ,   Life Insurance Election

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 150 150 0 0 0 0
Annual Time Burden (Hours) 38 38 0 0 0 0
Annual Cost Burden (Dollars) 1,009 1,009 0 0 0 0
No
No

$11,689
No
    Yes
    Yes
No
No
No
No
Charles Conyers 202 606-0125 charles.conyers@opm.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/07/2022


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