Information Collection

Survivor Benefit Plan (SBP) Election Change Certificate

IC 241189 under ICR 202304-0704-002 · OMB 0704-0569.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD 2656-6 Survivor Benefit Plan (SBP) Election Change Certificate	Form and Instruction
DD 2656-6 Survivor Benefit Plan Election Change Certificate dd2656-6.PDF	Form and Instruction
DD 2656-6 Survivor Benefit Plan Election Change Certificate dd2656-6.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

IC Title:

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:

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	DD 2656-6	Survivor Benefit Plan Election Change Certificate	dd2656-6.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: 16,900

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	16,900	16,900
Annual IC Time Burden (Hours)	4,225	4,225
Annual IC Cost Burden (Dollars)	111,371	111,371

Documents for IC

table that charts IC Documents
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.