Information Collection

Opm 2809: Health Benefits Registration Form Opm 2809, Ez-1, 2: Health Benefits Enrollment Change Form

IC 156940 under ICR 199008-3206-007 · OMB 3206-0141.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	OPM 2809: HEALTH BENEFITS REGISTRATION FORM OPM 2809, EZ-1, 2: HEALTH BENEFITS ENROLLMENT CHANGE FORM	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.	Available Electronically?	Can Be Submitted Electronically?
Form	EZ-1, 2	No	No
Form	OPM 2809	No	No
Form	2809	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 285,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	285,500	285,500
Annual IC Time Burden (Hours)	142,750	142,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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