Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement

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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
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All Historical Document Collections

201810-3206-002 Approved without change	Reinstatement without change of a previously approved collection	2018-10-19
201305-3206-001 Approved without change	Existing collection in use without an OMB Control Number	2013-11-05

OMB Details

SF 2812

Federal Enterprise Architecture: General Government - Central Personnel

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.