Standard Form 2810 - Notice Of Change In Health Benefits Enrollment Page 3
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4Disposition Instructions To Payroll Offices
Copy 2 -
Send to insurance carrier, attached to Transmittal Report to Carrier (SF 2811), at the earliest possible date.
Under no circumstances should SF 2810s be accumulated for longer than a week, nor should they be delayed to
coincide with applicable payroll deductions.
Copy 3 -
Use as payroll action document, if necessary.
Copy 4 -
In cases of death or retirement under the Civil Service Retirement System or the Federal Employees Retirement
System, send to the Office of Personnel Management together with the Official Personnel Folder copy of each
Health Benefits Registration Form (SF 2809) accepted from the employee including any Medical Certificates
attached thereto, Individual Retirement Record (SF 2806 [CSRS] or SF 3100 [FERS]) and any other applicable
documents. For other retirement systems (including Office of Workers’ Compensation Programs, Department of
Labor), send these documents (or the equivalent) to the office administering the system.
Back, Copy 3
Standard Form 2810
Revised June 1995
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Parent category: Medical