Section 1: general instructions
When first eligible for FEGLI, an employee may do nothing and have Basic automatically, elect Basic and any or all of the options, or waive all life insurance coverage.
SF2817
Life Insurance Election
- Agency
- GSA
- Revision
- Revised November 2011
- Fillable fields
- 37
- Pages
- 5
- Official source
- GSA form page
- Checked
- October 20, 2026
Standard Form 2817 (SF 2817): Life Insurance Election
Standard Form 2817 (SF 2817), Life Insurance Election, is the election form for the Federal Employees' Group Life Insurance (FEGLI) Program. It is a U.S. Office of Personnel Management (OPM) form, Revised November 2011, with OMB No. 3206-0230. GSA hosts a copy in its forms library.
The form says that by law, unless an employee waives all coverage or is ineligible, the employee is automatically covered for Basic life insurance. On SF 2817 an employee signs to elect or keep Basic, signs for any of Option A (Standard), Option B (Additional) and Option C (Family), or signs to waive all life insurance. The form says the election supersedes all previous elections.
The employee gives all parts to the employing office, which completes Section 6 and returns the employee's copy. That copy, with the FEGLI Program Booklet, is the employee's certificate of insurance. OPM estimates an average of 15 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 2817
Section 2: identifying information
Name, date of birth, Social Security Number, employing department or agency, OWCP claim number if applicable, work location and daytime telephone number.
Section 3: Basic
A signature and date to elect or keep Basic and authorize deductions for the employee's share. The form says Basic may be provided without cost to U.S. Postal Service employees.
Section 4: Options A, B and C
Signature blocks for Option A, Option B at 1 to 5 times annual basic pay, and Option C at 1 to 5 multiples. The form says each Option C multiple is worth $5,000 upon the death of a spouse and $2,500 upon the death of an eligible child.
Section 5: waiver of all coverage
A signature to have no life insurance. The form says coverage stops at the end of the last day of the pay period in which the employing office receives the waiver.
Section 6: agency use
Remarks, name and address of the employing office, date received, effective date of coverage, number of the event permitting the change and the signature of an authorized agency official.
Part 1 is filed in the Official Personnel Folder. Part 2, for agency use, repeats Sections 2 to 6 and adds Section 7 for insurance codes.
How to complete SF 2817
- 1
Read the instructions for employees
The back of Part 3 covers new employees, prior service, reemployed annuitants, assignments and workers' compensation. The form also points to the FEGLI Program Booklet (FE 76-21, or FE 76-20 for U.S. Postal Service employees).
- 2
Sign Section 3 for Basic
The form says that without a signature for Basic in Section 3, the employee or assignee may not elect or retain any form of optional insurance.
- 3
Sign each option wanted in Section 4
For Option B or C, mark one of the five boxes for the number of multiples. The form says there is no coverage for any option not signed for, even one elected before.
- 4
Or sign Section 5 to waive all
Signing Section 5 waives all FEGLI coverage. The form lists the ways to get Basic again: waiting at least 1 year and giving satisfactory medical information, a life event, a break in service of at least 180 days, or an open season.
- 5
Check who signs
Only the employee may sign Sections 3, 4 or 5, except that an assignee signs to waive or reduce assigned coverage. Signatures by guardians, conservators or through a power of attorney are not valid.
- 6
Give the whole form to HR
The instructions say to send the entire form, without separating the parts, to the human resources office, and not to send it to OPM or OFEGLI.
Why fill Form SF2817 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the GSA, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes, timing and what the form says
Where it goes
To the employee's human resources or employing office. When an assignee files and the insured is an annuitant, the instructions name OPM, Retirement Operations Center, P.O. Box 45, Boyers, PA 16017-0045.
Time limits printed on the form
The agency instructions ask new employees to return it as soon as possible, preferably before the end of the first pay period, but no later than 60 days after appointment. For a life event, the agency receives the form and proof of the event within 60 days after the event.
Table of Effective Dates
The back of Part 2 lists when coverage starts for each event: new employee, medical information approved through SF 2822, life event, reinstatement, canceling or reducing, open season, and certain employees under Public Laws 106-398 and 110-417.
Checking the election
After processing, the employee receives an SF 50, Notification of Personnel Action, with a two digit insurance code explained in Part 2. The form also suggests checking the pay statement for the correct withholdings.
Privacy and burden
Chapter 87, title 5, U.S. Code authorizes the collection. OPM estimates an average of 15 minutes to complete the form, and the OMB Number is 3206-0230.
Related forms
SF2822
Request for Insurance - Federal Employees' Group Life Insurance (FEGLI) Program
68 fields, 4 pages
SF2823
Designation of Beneficiary - FEGLI
64 fields, 3 pages
SF2818
Continuation of Life Insurance Coverage as an Annuitant or Compensationer (FEGLI)
30 fields, 5 pages
SF2819
Notice of Conversion Privilege - Federal Employees' Life Insurance Program
22 fields, 3 pages
SF2821
Agency Certification of Insurance Status - Federal Employees' Group Life Insurance Program
67 fields, 4 pages
Who files SF 2817?
The Instructions for Agencies on the back of Part 1 list who should file it.
Official sources and the blank
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Questions about Form SF2817
Who issues SF 2817?
The form is printed as a U.S. Office of Personnel Management form, OMB No. 3206-0230, Revised November 2011. GSA hosts a copy in its forms library.
Is SF 2817 needed to get Basic life insurance?
The form says new employees are automatically enrolled in Basic unless they waive it, and new employees who want only Basic do not have to file.
What happens to an option that is not signed for?
The form says there is no coverage for any option not signed for, regardless of whether it was elected before, and that future opportunities to enroll in it are strictly limited.
Can someone else sign SF 2817?
Only the employee may sign Sections 3, 4 or 5. Signatures by guardians, conservators or through a power of attorney are not valid. The exception is an assignee, who may waive or reduce assigned coverage but cannot increase it.
What is each Option C multiple worth?
The form says each multiple is worth $5,000 upon the death of a spouse and $2,500 upon the death of an eligible child.
Where is SF 2817 sent?
The instructions say to send the entire form, without separating the parts, to the human resources office, and not to send it to OPM or OFEGLI.
How long does SF 2817 take to fill out?
OPM estimates an average of 15 minutes, including time for getting the needed data and reviewing both the instructions and the completed form.