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Federal forms, ICRs, and supporting documents

Information Collection

Survivor Benefit Plan (SBP) Election Statement for Former Spouse Coverage

IC 241181 under ICR 202304-0704-002 · OMB 0704-0569.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

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Survivor Benefit Plan (SBP) Election Statement for Former Spouse Coverage
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
5 CFR 1320.5(d)(2)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction DD 2656-1 Survivor Benefit (SBP) Election Statement For Former Spouse Coverage dd2656-1.PDF Yes Yes Fillable Fileable Signable

Defense and National Security Operational Defense

Privacy Act of 1974; System of Records  74 FR 396

9,500 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 9,500 0 0 0 0 9,500
Annual IC Time Burden (Hours) 2,375 0 0 0 0 2,375
Annual IC Cost Burden (Dollars) 62,605 0 0 0 0 62,605

Title Document Date Uploaded
SSN Justification 0704-0569_ SSN Justification (DD 2656).pdf 04/07/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.