Information Collection

Open Season Health Benefits Enrollment Change Form For Annuitants (1 Part) Sf 2809ez & Sv 2809 O/p For Other Annuitant Use

IC 176770 under ICR 198406-3206-004 · OMB 3206-0141.

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Information Collection (IC) Details

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IC Title:	OPEN SEASON HEALTH BENEFITS ENROLLMENT CHANGE FORM FOR ANNUITANTS (1 PART) SF 2809EZ & SV 2809 O/P FOR OTHER ANNUITANT USE	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SF 2809 O/P				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	60,000	0	60,000
Annual IC Time Burden (Hours)	7,500	-7,500	15,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.