Header: office, report and pay period
Address of the reporting office, payroll office number, report number, month reported on the Statement of Transactions, date payroll paid, pay period from and to, and a telephone number.
SF2812
Report of Withholdings and Contributions for Health Benefits, Life Insurance, and Retirement
- Agency
- GSA
- Revision
- Revised October 2014
- Fillable fields
- 60
- Pages
- 1
- Official source
- GSA form page
- Checked
- October 20, 2026
Standard Form 2812 (SF 2812): Report of Withholdings and Contributions
Standard Form 2812 (SF 2812), Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement, is an Office of Personnel Management (OPM) form, Revised October 2014, with OMB 3206-0262 and Interagency Report No. 1064-OPM-AR. It lists the CSRS/FERS Handbook for Personnel and Payroll Offices, and GSA hosts a copy in its forms library.
The report is addressed to OPM, Funds Management. For one payroll it lists withholdings, contributions and totals by benefit category: life insurance, health benefits and retirement under CSRS and FERS. An authorized Administrative or Certifying Officer signs to certify that the items are correct and the amount is available to be credited to the OPM receipt account.
The footer says the form may be locally reproduced, and OPM estimates an average of 30 minutes to complete it. You can fill it out free in your browser on this page and download the result without an account.
What's on SF 2812
Life insurance
Basic Life, Standard Option A, Additional Option B, Family Option C and Post-Retirement, with a total for life insurance.
Health benefits
Regular, and Temporary Continuation of Coverage (TCC) under P.L. 100-654, with a total for health benefits.
CSRS retirement
All Categories, Salary Offset for Reemployed Annuitants, and Military and Civilian Service Credit.
FERS, FERS RAE and FERS FRAE
Regular, Military Reserve Technician, Special, Salary Offset for Reemployed Annuitants and Military Deposit lines for each of the three FERS groups, then Total Retirement and a Grand Total.
Footnotes and burden statement
Footnotes list the CPDF Retirement Codes for each retirement line, and the public burden statement shows OMB Number 3206-0262.
Each benefit line has columns for withholdings, contributions and the total.
How SF 2812 is completed
- 1
Identify the office and payroll
Enter the reporting office's address, payroll office number, report number and telephone number, the month reported on the Statement of Transactions, the date payroll was paid and the pay period dates.
- 2
Enter life insurance and health benefits
Enter withholdings and contributions on each life insurance and health benefits line, with the totals for each category.
- 3
Enter retirement by CPDF code
The footnotes say which CPDF Retirement Codes belong on each line: 1, 6, C, E, R or T for CSRS All Categories, L, M or O for FERS Special, LR, MR or OR for Special RAE, and LF, MF or OF for Special FRAE.
- 4
Certify and sign
The authorized Administrative or Certifying Officer signs and dates the certification once Total Retirement and the Grand Total are entered.
- 5
Send it to OPM
The form is addressed to OFFICE OF PERSONNEL MANAGEMENT, ATTN: FUNDS MANAGEMENT, POST OFFICE BOX 582, WASHINGTON, DC 20044-0582.
Why fill Form SF2812 on indox
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Where it goes and what the form says
Where it goes
The To block reads OFFICE OF PERSONNEL MANAGEMENT, ATTN: FUNDS MANAGEMENT, POST OFFICE BOX 582, WASHINGTON, DC 20044-0582.
Time to complete
OPM estimates an average of 30 minutes, including the time for reviewing instructions, getting the needed data and reviewing the completed form.
Copies and OMB number
The footer says the form may be locally reproduced. The burden statement says OMB Number 3206-0262 is currently valid and that OPM may not collect the information unless the number is displayed.
Related forms
SF2812A
Report of Withholdings and Contributions for Health Benefits by Enrollment Code
279 fields, 1 page
SF2810
Notice of Change in Health Benefits Enrollment
29 fields, 7 pages
SF2809
Health Benefits Election Form
100 fields, 18 pages
SF2817
Life Insurance Election
37 fields, 5 pages
SF2806
Individual Retirement Record - Civil Service Retirement System (CSRS)
242 fields, 1 page
Who completes SF 2812?
SF 2812 is an agency report to OPM, not a form for individual employees. The form prints these roles.
Official sources and the blank
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Questions about Form SF2812
Who issues SF 2812?
The form is printed as an Office of Personnel Management form, Revised October 2014, OMB 3206-0262, and lists the CSRS/FERS Handbook for Personnel and Payroll Offices. GSA hosts a copy in its forms library.
Do individual employees file SF 2812?
The form is an office report of payroll totals. It is signed by an authorized Administrative or Certifying Officer and addressed to OPM, and it has no item for an individual employee's name.
Where does SF 2812 go?
The To block reads OFFICE OF PERSONNEL MANAGEMENT, ATTN: FUNDS MANAGEMENT, POST OFFICE BOX 582, WASHINGTON, DC 20044-0582.
Which benefit categories does SF 2812 cover?
Life insurance (Basic, Options A, B and C, and Post-Retirement), health benefits (Regular and TCC) and retirement (CSRS, FERS, FERS RAE and FERS FRAE), each with withholdings, contributions and totals.
What are the CPDF codes in the footnotes?
They show which employees belong on each retirement line, by CPDF Retirement Code. For example, the form puts codes 1, 6, C, E, R or T under CSRS All Categories and L, M or O under FERS Special.
How long does SF 2812 take?
OPM estimates an average of 30 minutes to complete it, including reviewing instructions, getting the needed data and reviewing the completed form.