Life Insurance Election

ICR 199902-3206-001

OMB: 3206-0230

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
33736 Migrated
ICR Details
3206-0230 199902-3206-001
Historical Active 199612-3206-003
OPM
Life Insurance Election
Revision of a currently approved collection   No
Emergency 02/24/1999
Approved without change 03/04/1999
Retrieve Notice of Action (NOA) 02/22/1999
  Inventory as of this Action Requested Previously Approved
06/30/1999 06/30/1999 02/29/2000
100 0 100
25 0 25
0 0 0

The SF-2817 Life Insurance Election is used by Federal employees and assignees (those who have acquired control of an employee's or annuitant's coverage through an assignment of life insurance). The form is used as the official agency record of an individual's coverage and enrollment status under FEGLI.

None
None


No

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

  Total Approved 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 100 100 0 0 0 0
Annual Time Burden (Hours) 25 25 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
02/22/1999


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