OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

INSTRUCTIONS FOR REQUEST TO CHANGE FEHB ENROLLMENT OR TO RECEIVE PLAN BROCHURES FOR SPOUSE EQUITY AND TEMPORARY CONTINUATION OF COVERAGE ENROLLEES

ICR 199109-3206-001 · OMB 3206-0202 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
157102 INSTRUCTIONS FOR REQUEST TO CHANGE FEHB ENROLLMENT OR TO RECEIVE PLAN BROCHURES FOR SPOUSE EQUITY AND TEMPORARY CONTINUATION OF COVERAGE ENROLLEES Form Migrated
ICR Details
3206-0202 199109-3206-001
Historical Active 199108-3206-001
OPM
INSTRUCTIONS FOR REQUEST TO CHANGE FEHB ENROLLMENT OR TO RECEIVE PLAN BROCHURES FOR SPOUSE EQUITY AND TEMPORARY CONTINUATION OF COVERAGE ENROLLEES
Revision of a currently approved collection   No
Regular
Approved without change 09/18/1991
Retrieve Notice of Action (NOA) 09/12/1991
1. By this action, OMB approves the instructions to DPRS Form 2809 so that both the form and the instructions are assisgned this OMB control number. 2. Approval for both the form and instructions will expire on 8/31/92 since by nature of the program, content of the information collection changes anually. 3. In the future, any request such as this to amend an existing approval action, should include all material the agency intends to be approved under the control number assigned. OPM's failure to do so may result in delays in consideration of its request for OMB approval.
  Inventory as of this Action Requested Previously Approved
08/31/1992 08/31/1992 08/31/1992
15,000 0 15,000
2,500 0 2,500
0 0 0
DPRS FORM 2809 IS USED BY INDIVIDUALS WHO ARE ELIGIBLE TO ELECT, CANCE OR CHANGE HEALTH BENEFITS ENROLLMENT DURING OPEN SEASON.
None
None
No
  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 15,000 15,000 0 0 0 0
Annual Time Burden (Hours) 2,500 2,500 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.
09/12/1991