Information Collection

Life Insurance Election

IC 33739 under ICR 201408-3206-005 · OMB 3206-0230.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SF 2817 Life Insurance Election	Form and Instruction
SF 2817 Life Insurance Election SF 2817 revised Nov 2014.pdf www.opm.gov/forms/pdf_fill/sf2817.pdf	Form and Instruction

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:

table that charts list of 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	SF 2817 revised Nov 2014.pdf	http://www.opm.gov/forms/pdf_fill/sf2817.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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.