Information Collection

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..

IC 156941 under ICR 199011-3206-001 · OMB 3206-0141.

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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, DPRS 2809, REQUEST TO CHANGE FEHB ENROLLMENT OR TO RECEIVE PLAN BROCHURES FOR..	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	2809 EZ-1, 2	No	No
Form	DPRS 2809	No	No
Form	OPM 2809	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 295,500	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	295,500	10,000	285,500
Annual IC Time Burden (Hours)	147,750	5,000	142,750
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.