Life Insurance Election

OMB 3206-0230

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).

The latest form for Life Insurance Election expires 2021-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SF 2817 Life Insurance Election Form and Instruction
OMB_Justification_SF2817_2022_03_07.docx Justification for No Material/Nonsubstantive Change
2021-03790.pdf Supplementary Document
SF2817_30DayFRN_Published_2021_07_12.pdf Supplementary Document
FACES 2017 FINAL 12212017signed.pdf Supplementary Document
ARS PIA Final 12212017signed.pdf Supplementary Document
Citations for SF 2817.pdf Supplementary Document
SF2817_OMBSupportingStmt_2021_06_16.docx Supporting Statement A
Life Insurance Election Form and Instruction

All Historical Document Collections

202203-3206-007 Approved without change	No material or nonsubstantive change to a currently approved collection	2022-03-07
202107-3206-001 Approved with change	Revision of a currently approved collection	2021-07-13
201803-3206-002 Approved with change	Reinstatement with change of a previously approved collection	2018-03-14
201408-3206-005 Approved without change	Revision of a currently approved collection	2014-08-29
201106-3206-009 Approved without change	Revision of a currently approved collection	2011-06-22
200904-3206-008 Approved without change	Reinstatement without change of a previously approved collection	2009-04-30
200508-3206-005 Approved without change	Extension without change of a currently approved collection	2005-08-19
200304-3206-001 Approved without change	Extension without change of a currently approved collection	2003-04-21
200003-3206-003 Approved without change	Reinstatement with change of a previously approved collection	2000-03-09
199902-3206-001 Approved without change	Revision of a currently approved collection	1999-02-22
199612-3206-003 Approved without change	New collection (Request for a new OMB Control Number)	1996-12-18