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Federal forms, ICRs, and supporting documents

Information Collection Request

OPEN SEASON HEALTH BENEFITS, ENROLLMENT CHANGE AND BROCHURE REQUEST

ICR 199308-3206-002 · OMB 3206-0201 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
157098 OPEN SEASON HEALTH BENEFITS, ENROLLMENT CHANGE AND BROCHURE REQUEST Form Migrated
ICR Details
3206-0201 199308-3206-002
Historical Active 199209-3206-001
OPM
OPEN SEASON HEALTH BENEFITS, ENROLLMENT CHANGE AND BROCHURE REQUEST
Revision of a currently approved collection   No
Regular
Approved without change 09/09/1993
Retrieve Notice of Action (NOA) 08/26/1993
  Inventory as of this Action Requested Previously Approved
08/31/1994 08/31/1994 10/31/1993
127,913 0 127,913
63,957 0 63,957
0 0 0
THIS FORM IS USED ONLY AT OPEN SEASON TO REQUEST AN ENROLLMENT CHANGE, INSURANCE PLAN BROCHURES, AND OTHER INFORMATIONAL MATERIALS. IF OPM FORM 2809-EZ1 IS USED TO REQUEST PLAN BROCHURES, AN OPM FORM 2809-EZ2 IS FURNISHED THE ENROLLEE FOR USE IF A PLAN CHANGE IS DESIRED. IT IS COMPLETED BY RETIREES, SURVIVOR ANNUITANTS, AND FORMER SPOUSES OF RETIREES.
None
None
No
1
IC Title Form No. Form Name
OPEN SEASON HEALTH BENEFITS, ENROLLMENT CHANGE AND BROCHURE REQUEST OPM 2809-EZ1
  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 127,913 127,913 0 0 0 0
Annual Time Burden (Hours) 63,957 63,957 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.
08/26/1993