OMB control number
Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement
OMB 3206-0262 · OPM.
OMB 3206-0262
Abstract: Public Law 112-96, Section 5001, the "Middle Class Tax Relief and Job Creation Act of 2012," requires OPM to collect information. OPM collects this information via the following forms: 1) Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement (Standard Form 2812); 2) Report of Withholdings and Contributions for Health Benefits By Enrollment Code (Standard Form 2812-A); 3) Supplemental Semiannual Headcount Report (OPM Form 1523). The current Standard Form 2812, Standard Form 2812-A, and OPM Form 1523 reflect that there is no change in the law.
The latest form for Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement expires 2021-11-30 and is listed under ICR 201810-3206-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form OPM 1523 OPM 1523 | Form and Instruction |
 Form SF 2812A SF 2812A | Form and Instruction |
| Form SF2812 SF 2812 | Form and Instruction |
 Supporting Stmt FERS-3206-0262.doc | Supporting Statement A |
| 30 Day Notice 2018-21918 50975 0262.pdf | Supplementary Document |
| 60 Day Notice 7505 2018-03439 0262.pdf | Supplementary Document |
 OPM 1523 |
Form and Instruction |
| SF 2812A |
Form and Instruction |
| SF 2812 |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201810-3206-002 | Reinstatement without change of a previously approved collection | 2018-10-19 | Approved without change | |
| 201305-3206-001 | Existing collection in use without an OMB Control Number | 2013-11-05 | Approved without change |
OMB Details
SF 2812
Federal Enterprise Architecture: General Government - Central Personnel
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form SF2812 | Report of Withholdings and Contributions for Health Benefits,Life Insurance and Retirement | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.