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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 202109-0505-002 · OMB 0505-0024 · Received in OIRA

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
0505-0024 - DPRS2809 SuppStmt - 2021.docx Supporting Statement A Uploaded 2021-10-29 Available
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 202109-0505-002
Received in OIRA 201809-0505-001
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 10/29/2021
  Requested Previously Approved
36 Months From Approved 10/31/2021
45,000 25,000
33,750 18,750
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
  86 FR 48114 08/27/2021
86 FR 59694 10/28/2021
No
  Total Request 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 45,000 25,000 0 0 20,000 0
Annual Time Burden (Hours) 33,750 18,750 0 0 15,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
There is an increase in the respondents, responses, and burden hours from the last approval due to a rise in the number of participants in the FEHB program.
$19,476
No
    Yes
    Yes
Yes
No
No
No
Alisa Wells 318 401-5833
  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.
10/29/2021