Af Form 2817 The form although the information in Section 2 must refer to the employee Please note that assignees cannot increase the employee s coverage Only the employee can do that The employee is solely responsible for ensuring that the SF 2817 accurately reflects his or her intentions If the employee is electing new coverage always make sure
Sign and date the form Forward the form to your Clinical Supervisor Make all entries in ink CLINICAL SUPERVISOR In Part I using the facility master privileges list enter Code 1 2 3 or 4 in each VERIFIED block in answer to each requested privilege AF IMT 2817 20020505 V1 PREVIOUS EDITION IS OBSOLETE PAGE 1 OF 3 PAGES I LIST Federal employees use this form to enroll increase decrease or cancel life insurance coverage New Federal employees in eligible positions are automatically covered by Basic Some agencies such as the Department of Defense use an electronic SF 2817 form ask the agency human resources office for more information Annuitants do not use this form
Af Form 2817
Af Form 2817
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Form SF 2817 Fill Out Sign Online And Download Fillable PDF
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https://www.opm.gov/forms/pdf_fill/sf2817.pdf
The form although the information in Section 2 must refer to the employee Please note that assignees cannot increase the employee s coverage Only the employee can do that The employee is solely responsible for ensuring that the SF 2817 accurately reflects his or her intentions If the employee is electing new coverage always make sure
https://static.e-publishing.af.mil/production/1/af_sg/form/af2817/af2817.pdf
Sign and date the form Forward the form to your Clinical Supervisor Make all entries in ink CLINICAL SUPERVISOR In Part I using the facility master privileges list enter Code 1 2 3 or 4 in each VERIFIED block in answer to each requested privilege AF IMT 2817 20020505 V1 PREVIOUS EDITION IS OBSOLETE PAGE 1 OF 3 PAGES I LIST
SF 2817 Edit Fill Sign Online Handypdf
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Standard Form 2817 Revised September 2021 Table of Effective Dates Changes in Life Insurance Coverage Deductions Begin increase stop or decrease in the same pay period in which coverage begins increases stops or decreases Event Allowing Change Change Permitted To elect any option employee must elect or retain Basic Option A Standard Form 2817 Life Insurance Election is used by Federal employees and assignees those who have acquired control of an employee annuitant s coverage through an assignment or transfer of the ownership of the life insurance The latest form for Life Insurance Election expires 2021 06 30 and can be found here
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A Once AF IMT Form 2817 1 is submitted changes can only be made with the approval of the appropriate medical staff and commanding officers Q What happens after AF IMT Form 2817 1 is approved A After AF IMT Form 2817 1 is approved the applicant will be granted the specified clinical privileges as a Pediatric Nurse Practitioner in the Air The form although the information in Section 2 must refer to the employee Please note that assignees cannot increase the employee s coverage Only the employee can do that The employee is solely responsible for ensuring that the SF 2817 accurately reflects his or her intentions Consult the FEGLI Program Booklet FE 76 21 or FE 76 20
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