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.
Document Name |
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Form and Instruction |
Form and Instruction |
Form and Instruction |
Supporting Statement A |
Supplementary Document |
Supplementary Document |
Approved without change |
Reinstatement without change of a previously approved collection | 2018-10-19 | |
Approved without change |
Existing collection in use without an OMB Control Number | 2013-11-05 |
Federal Enterprise Architecture: General Government - Central Personnel
Form SF2812 | Report of Withholdings and Contributions for Health Benefits,Life Insurance and Retirement | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.