Sf 2812a

Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0262 can be found here:

Documents and Forms

Document Name Document Type
Form SF 2812A SF 2812A Form and Instruction
SF 2812A Report of Withholdings and Contributions for Health Bene sf2812a.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	SF 2812A	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SF 2812A	Report of Withholdings and Contributions for Health Benefits by Enrollment Code	sf2812a.pdf		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,600	2,600
Annual IC Time Burden (Hours)	1,300	1,300
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.