Information Collection

Survivor Benefit Plan (SBP) Election Change Certificate

IC 241189 under ICR 202607-0704-013 · OMB 0704-0569.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD 2656-6 Survivor Benefit Plan Election Change Certificate Survivor Benefit Plan (SBP) Election Change Certificate	Form and Instruction
DD 2656-6 Survivor Benefit Plan Election Change Certificate dd2656-6 DRAFT 20260710.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: Modified

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				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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	16,900	0	16,900
Annual IC Time Burden (Hours)	4,225	0	4,225
Annual IC Cost Burden (Dollars)	111,287	-84	111,371

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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