Information Collection

Application for Death Benefits Under the Civil Service Retirement System

IC 33627 under ICR 202106-3206-012 · OMB 3206-0156.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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 Under CSRS SF2800_2021_09_MarkUp.pdf www.opm.gov	Form and Instruction
SF 2800 Application for Death Benefits Under CSRS SF2800_2021_09_MarkUp.pdf www.opm.gov	Form and Instruction
SF 2800 Application for Death Benefits Under CSRS SF2800_2018_06_MarkUp.pdf www.opm.gov	Form and Instruction
SF 2800 Application for Death Benefits Under CSRS SF2800_2018_06_MarkUp.pdf www.opm.gov	Form and Instruction
SF 2800A Documentation and Elections in Support of Application fo SF2800A_2021_09_MarkUp.pdf www.opm.gov	Form and Instruction
SF 2800A Documentation and Elections in Support of Application fo SF2800A_2021_09_MarkUp.pdf www.opm.gov	Form and Instruction
SF 2800A Documentation and Elections in Support of Application fo SF2800A_2018_06.pdf www.opm.gov	Form and Instruction
SF 2800A Documentation and Elections in Support of Application fo SF2800A_2018_06.pdf www.opm.gov	Form and Instruction

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:

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 2800	Application for Death Benefits Under CSRS	SF2800_2021_09_MarkUp.pdf	www.opm.gov	Yes	No	Fillable Printable
Form and Instruction	SF 2800	Application for Death Benefits Under CSRS	SF2800_2018_06_MarkUp.pdf	www.opm.gov	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	SF2800A_2021_09_MarkUp.pdf	www.opm.gov	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	SF2800A_2018_06.pdf	www.opm.gov	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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	74,800	0	74,800
Annual IC Time Burden (Hours)	56,100	0	56,100
Annual IC Cost Burden (Dollars)	813,565	813,565	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.