OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Request to Change FEHB Enrollment or to Receive Plan Brochures for Spouse Equity/Temporary Continuation of Coverage Enrollees/Direct Pay Annuitants

ICR 200806-3206-001 · OMB 3206-0202 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form DPRS-2809 Request to Change FEHB Enrollment or to Receive Plan Brochures for Spouse Equity/Temporary Continuation of Coverage Enrollees/Direct Pay Annuitants Form and Instruction Modified Repair queued
DPRS 2809 SS.doc Supporting Statement A Uploaded 2008-06-25 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
33692 Request to Change FEHB Enrollment or to Receive Plan Brochures for Spouse Equity/Temporary Continuation of Coverage Enrollees/Direct Pay Annuitants Form and Instruction Modified
ICR Details
3206-0202 200806-3206-001
Historical Active 200412-3206-002
OPM
Request to Change FEHB Enrollment or to Receive Plan Brochures for Spouse Equity/Temporary Continuation of Coverage Enrollees/Direct Pay Annuitants
Revision of a currently approved collection   No
Regular
Approved without change 08/01/2008
Retrieve Notice of Action (NOA) 06/26/2008
  Inventory as of this Action Requested Previously Approved
08/31/2011 36 Months From Approved 07/31/2008
27,000 0 27,000
20,250 0 20,250
0 0 0
The Direct Pay Remittance System (DPRS) 2809 is used by enrollees under the Spouse Equity and Temporary Continuation of Coverage provisions of FEHB law, and by annuitants who pay their premiums directly to the retirement system. During the annual FEHB open season, these enrollees use this form to change their enrollment.
US Code: 5 USC 8905 Name of Law: Health Insurance Election of Coverage
  
None
Not associated with rulemaking
  72 FR 37276 07/09/2007
73 FR 35421 06/23/2008
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 27,000 27,000 0 0 0 0
Annual Time Burden (Hours) 20,250 20,250 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$16,000
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Mary Beth Smith-Toomey 202-606-8358 [email protected]
  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.
06/26/2008