Information Collection

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

IC 241181 under ICR 202607-0704-013 · OMB 0704-0569.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD 2656-1 Survivor Benefit (SBP) Election Statement For Former Spouse Coverage 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
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: Removed

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 2656-1				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 %

table that charts list of burden
	Program Change Due to Agency Discretion	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

table that charts IC Documents
Title	Document	Date Uploaded
SSN Justification		04/07/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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