GSA Forms Library

Please enter a search term in the box above

Form: SF2812A

Report of Withholdings and Contributions for Health Benefits by Enrollment Code

Current Revision Date: 11/2013

Authority or Regulation: CSRS/FERS Handbook for Personnel and Payroll Offices


Choose a link below to begin downloading.

  1. SF2812A-13.pdf [PDF - 249 KB ]

    .PDF versions of forms use Adobe Reader. Download Adobe Reader™