Life Insurance Election

ICR 200003-3206-003

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
33737 Migrated
ICR Details
3206-0230 200003-3206-003
Historical Active 199902-3206-001
OPM
Life Insurance Election
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 05/24/2000
Retrieve Notice of Action (NOA) 03/09/2000
  Inventory as of this Action Requested Previously Approved
08/31/2003 08/31/2003
100 0 0
25 0 0
0 0 0

SF 2817, Life Insurance Election, is used by Federal employees and assignees (those who have acquired ownership and control of an employee's or annuitant's coverage through the enrollee's assignment of life insurance). The form is used as the official agency record of the individual's coverage and enrollment status under the FEGLI program, and as acknowledgment and authorization by the individual for collection from him or her of the enrollee share of the premium contributions.

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 0 0 100 0 0
Annual Time Burden (Hours) 25 0 0 25 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
03/09/2000


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