OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201810-3206-002 · OMB 3206-0262 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form OPM 1523 OPM 1523 Form and Instruction Modified Available
Form SF 2812A SF 2812A Form and Instruction Modified Available
Form SF2812 SF 2812 Form and Instruction Modified Available
Supporting Stmt FERS-3206-0262.doc Supporting Statement A Uploaded 2018-10-25 Available
30 Day Notice 2018-21918 50975 0262.pdf Supplementary Document Uploaded 2018-10-17 Available
60 Day Notice 7505 2018-03439 0262.pdf Supplementary Document Uploaded 2018-10-17 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
209211 OPM 1523 Form and Instruction Modified
209210 SF 2812A Form and Instruction Modified
209209 SF 2812 Form and Instruction Modified
ICR Details
3206-0262 201810-3206-002
Active 201305-3206-001
OPM
Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 11/19/2018
Retrieve Notice of Action (NOA) 10/19/2018
  Inventory as of this Action Requested Previously Approved
11/30/2021 36 Months From Approved
5,400 0 0
2,700 0 0
0 0 0
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.
PL: Pub.L. 112 - 96 5001 Name of Law: Middle Class Tax Relief and Job Creation Act of 2012
   US Code: 5 USC 83, 84, 87, 89 Name of Law: null
  
None
Not associated with rulemaking
  83 FR 7504 02/21/2018
83 FR 50975 10/10/2018
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,400 0 0 0 0 5,400
Annual Time Burden (Hours) 2,700 0 0 0 0 2,700
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$75,600
No
    No
    Yes
No
No
No
Uncollected
Demetrius Jones 202 606-5203 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/19/2018