Information Collection

Federal Employees Health Benefits Registraiton Form Sf 2809 O/p -- Open Season Health Benefits Enrollment Change Form For Annuitants - Sf 2809 Ez

IC 176771 under ICR 198609-3206-010 · OMB 3206-0141.

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Information Collection (IC) Details

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IC Title:	FEDERAL EMPLOYEES HEALTH BENEFITS REGISTRAITON FORM SF 2809 O/P -- OPEN SEASON HEALTH BENEFITS ENROLLMENT CHANGE FORM FOR ANNUITANTS - SF 2809 EZ	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-EZ				No	No
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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	55,600	-4,400	60,000
Annual IC Time Burden (Hours)	6,950	-550	7,500
Annual IC Cost Burden (Dollars)	0	0	0

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