Application for Death Benefits Under the Civil Service Retirement System

SF 2800, Application for Death Benefits Under the Civil Service Retirement System/SF 2800A, Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0156 can be found here:

Documents and Forms

Document Name Document Type
Form SF 2800 Application for Death Benefits Under the Civil Service Retirement System Form and Instruction
SF 2800 Application for Death Benefits, Civil Service Retirement SF 2800 (11-11).pdf Form and Instruction
SF 2800A Documentation and Elections in Support of Application fo SF 2800A March 2012.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Application for Death Benefits Under the Civil Service Retirement System	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR Ch. 1, Sec. 831 - Subpart F (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 2800	Application for Death Benefits, Civil Service Retirement System	SF 2800 (11-11).pdf		Yes	No	Fillable Printable
Form and Instruction	SF 2800A	Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee at the Time of Death	SF 2800A March 2012.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: 74,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	74,800	74,800
Annual IC Time Burden (Hours)	56,100	56,100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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