OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

IC 33692 under ICR 201108-3206-002 · OMB 3206-0202.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Request to Change FEHB Enrollment or to Receive Plan Brochures for Spouse Equity/Temporary Continuation of Coverage Enrollees/Direct Pay Annuitants
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction DPRS 2809 Request to Change FEHB or to Receive Plan Brochures for Spouse Equity/Temporary Continuation of Coverage Enrollees/Direct Pay Annuitant DPRS 2809.pdf Yes No Fillable Printable

General Government Executive Functions

OPM/Central-1  73 FR 15013

27,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 27,000 0 0 0 0 27,000
Annual IC Time Burden (Hours) 20,250 0 0 0 0 20,250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
2008 Markups 2008 Markups.pdf 08/18/2011
2011 Markups 2011 Markups.pdf 08/18/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.