OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

FEDERAL EMPLOYEES HEALTH BENEFITS REGISTRAITON FORM SF 2809 O/P -- OPEN SEASON HEALTH BENEFITS ENROLLMENT CHANGE FORM FOR ANNUITANTS - SF 2809 EZ

ICR 198407-3206-001 · OMB 3206-0141 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
156938 FEDERAL EMPLOYEES HEALTH BENEFITS REGISTRAITON FORM SF 2809 O/P -- OPEN SEASON HEALTH BENEFITS ENROLLMENT CHANGE FORM FOR ANNUITANTS - SF 2809 EZ Form Migrated
ICR Details
3206-0141 198407-3206-001
Historical Active 198406-3206-004
OPM
FEDERAL EMPLOYEES HEALTH BENEFITS REGISTRAITON FORM SF 2809 O/P -- OPEN SEASON HEALTH BENEFITS ENROLLMENT CHANGE FORM FOR ANNUITANTS - SF 2809 EZ
Revision of a currently approved collection   No
Regular
Approved without change 08/07/1984
Retrieve Notice of Action (NOA) 07/27/1984
  Inventory as of this Action Requested Previously Approved
08/31/1987 08/31/1987 05/31/1987
60,000 0 60,000
7,500 0 7,500
0 0 0
THE ONE-PART SF 2809 EZ IS USED BY ANNUITANTS AND SURVIVOR ANNUITANTS WHO CHOOSE TO CHANGE HEALTH BENEFIT PLANS DURING OPEN SEASON ONLY. THE FOUR PART SF 2809 O/P IS USED TO ELECT, CANCEL OR CHANGE HEALTH BENEFITS DURING PERIODS OTHER THAN OPEN SEASON.
None
None
No
1
IC Title Form No. Form Name
FEDERAL EMPLOYEES HEALTH BENEFITS REGISTRAITON FORM SF 2809 O/P -- OPEN SEASON HEALTH BENEFITS ENROLLMENT CHANGE FORM FOR ANNUITANTS - SF 2809 EZ SF 2809-EZ, SF 2809-O/P
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 60,000 60,000 0 0 0 0
Annual Time Burden (Hours) 7,500 7,500 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/27/1984