Information Collection

Life Insurance Election

IC 33739 under ICR 202203-3206-007 · OMB 3206-0230.

Documents and Forms

Document Name Document Type
Form SF 2817 Life Insurance Election Form and Instruction
SF 2817 Life Insurance Election SF2817_2021_09_MarkUp.pdf www.opm.gov Form and Instruction
SF 2817 Life Insurance Election SF2817_2021_09_MarkUp.pdf www.opm.gov Form and Instruction
SF 2817 Life Insurance Election SF2817_2018_06_MarkUp.pdf www.opm.gov Form and Instruction
SF 2817 Life Insurance Election SF2817_2018_06_MarkUp.pdf www.opm.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Life Insurance Election	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 5 CFR CH 1, PART 870, FEGLI Program (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SF 2817	Life Insurance Election	SF2817_2021_09_MarkUp.pdf	www.opm.gov	Yes	No	Fillable Printable
Form and Instruction	SF 2817	Life Insurance Election	SF2817_2018_06_MarkUp.pdf	www.opm.gov	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title: OPM/Central-1	FR Citation: 73 FR 15013

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	1,009	1,009

Documents for IC

Title	Document	Date Uploaded
No associated records found

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