Life Insurance Election

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0230 can be found here:

Documents and Forms

Document Name Document Type
Form SF 2817 Life Insurance Election Form and Instruction
SF 2817 Life Insurance Election SF2817_November2011.pdf Form and Instruction
SF2817_November2011_MarkUps.pdf SF 2817_November2011_Markup IC Document
SF 2817 June 2000 Markup.pdf SF 2817 June 2000 Markup IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Life Insurance Election	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR CH 1, PART 870, FEGLI Program (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SF 2817	Life Insurance Election	SF2817_November2011.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title: OPM/Central-1	FR Citation: 73 FR 15013

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	150	0	150
Annual IC Time Burden (Hours)	38	13	25
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SF 2817_November2011_Markup	SF2817_November2011_MarkUps.pdf	06/22/2011
SF 2817 June 2000 Markup	SF 2817 June 2000 Markup.pdf	06/22/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.