Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement

OMB 3206-0262

OMB 3206-0262

Abstract: Public Law 112-96, Section 5001, the "Middle Class Tax Relief and Job Creation Act of 2012," requires OPM to collect information. OPM collects this information via the following forms: 1) Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement (Standard Form 2812); 2) Report of Withholdings and Contributions for Health Benefits By Enrollment Code (Standard Form 2812-A); 3) Supplemental Semiannual Headcount Report (OPM Form 1523). The current Standard Form 2812, Standard Form 2812-A, and OPM Form 1523 reflect that there is no change in the law.

The latest form for Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement expires 2021-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material
OMB Details

SF 2812

Federal Enterprise Architecture: General Government - Central Personnel

Form SF2812 Report of Withholdings and Contributions for Health Benefits,Life Insurance and Retirement Fillable FileableForm and instruction

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