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

Data for Payment of Retired Personnel

Documents and Forms

Document Name Document Type
Form DD 2656-1 Survivor Benefit Plan (SBP) Election Statement for Former Spouse Coverage Form and Instruction
DD 2656-1 Survivor Benefit (SBP) Election Statement For Former Spo dd2656-1.PDF Form and Instruction
DD 2656-1 Survivor Benefit (SBP) Election Statement For Former Spo dd2656-1.PDF Form and Instruction
0704-0569_ SSN Justification (DD 2656).pdf SSN Justification IC Document
0704-0569_ SSN Justification (DD 2656).pdf SSN Justification IC Document

Information Collection (IC) Details

IC Title:	Survivor Benefit Plan (SBP) Election Statement for Former Spouse Coverage	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 1320.5(d)(2)

Information Collection Instruments:

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

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title: Privacy Act of 1974; System of Records	FR Citation: 74 FR 396

Number of Respondents: 9,500	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	9,500	9,500
Annual IC Time Burden (Hours)	2,375	2,375
Annual IC Cost Burden (Dollars)	62,605	62,605

Documents for IC

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.