1. This action by OMB adds to the existing approval under OMB control number 3206-0141, the DPRS Form 2809 and its instructions. 2. This action changes the expiration date for all forms approved under this control number to June 1991. 3. This change in the expiration date is made because of the large amount of public comment being received at OMB during the current open season regarding the confusing nature of the instructions. Specifically, individuals receiving open season material have complained about the burden associated with understanding the form due to a lack of clarity regarding what to do if no change in health benefit plan is desired. Representative letters received by OMB on this subject are being forwarded to Ron Trueworthy of OPM under seperate cover. 4. In its next request for approval of these forms, prior to the next open season, OPM should demonstrate responsiveness to the complaints described above by making modifications to the draft open season material submitted for OPM approval.
Inventory as of this Action
Requested
Previously Approved
06/30/1991
06/30/1991
06/30/1992
295,500
0
285,500
147,750
0
142,750
0
0
0
OPM 2809 IS USED TO ELECT, CANCEL OR CHANGE HEALTH BENEFITS DURING PERIODS OTHER THAN OPEN SEASON. OPM 2809 EZ-1, 2 ARE USED BY ANNUITANT AND SURVIVOR ANNUITANTS WHO CHOOSE TO CHANGE HEALTH BENEFITS DURING OPEN SEASON. DPRS 2809 IS USED BY FORMER SPOUSE AND TEMPORARY CONTINUATION OF COVERAGE ENROLLEES, DURING OPEN SEASON, TO CHANGE FEHB
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.
OPM 2809-HEALTH BENEFITS REGISTRATION FORM, OPM 2809 EZ-1, 2 HEALTH BENEFITS ENROLLMENT CHANGE FORM, DPRS 2809, REQUEST TO CHANGE FEHB ENROLLMENT OR TO RECEIVE PLAN BROCHURES FOR..