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 201206-0505-001 · OMB 0505-0024 · 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 Available
2011 Markups.pdf Supplementary Document Uploaded 2011-10-11 Repair queued
2008 Markups.pdf Supplementary Document Uploaded 2011-10-11 Repair queued
30-day FRN.pdf Supplementary Document Uploaded 2011-08-25 Repair queued
60-day FRN.pdf Supplementary Document Uploaded 2011-08-18 Repair queued
DPRS2809_OMBSuppStmt_7_2011.doc Supporting Statement A Uploaded 2011-08-18 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
0505-0024 201206-0505-001
Historical Active 200806-3206-001
USDA/OCFO
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 with change 06/13/2012
Retrieve Notice of Action (NOA) 06/13/2012
This collection is cleared based on the revised materials provided by the agency.
  Inventory as of this Action Requested Previously Approved
10/31/2014 36 Months From Approved
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. Several changes have been made to this information collection that makes it consistent with the Affordable Care Act (P. L. 111-48).
US Code: 5 USC 8905 Name of Law: Health Insurance Election of Coverage
  
None
Not associated with rulemaking
  76 FR 18810 04/05/2011
76 FR 53156 08/25/2011
Yes
  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
Yes
No
No
Uncollected
Miles Windsor 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.
08/25/2011