Health Benefits Registration Form (fehbp), Health Benefits Enrollment Change Form, Enrollment Code Form & Brochure Request Form, & Enrollment Change Form

HEALTH BENEFITS REGISTRATION FORM (FEHBP), HEALTH BENEFITS ENROLLMENT CHANGE FORM, ENROLLMENT CODE FORM & BROCHURE REQUEST FORM, & ENROLLMENT CHANGE FORM

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0141 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	HEALTH BENEFITS REGISTRATION FORM (FEHBP), HEALTH BENEFITS ENROLLMENT CHANGE FORM, ENROLLMENT CODE FORM & BROCHURE REQUEST FORM, & ENROLLMENT CHANGE FORM	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	2809 O/P	No	No
Form	2809-EZ2	No	No
Form	2809-EZ1	No	No
Form	2809-Y	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 285,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	285,500	0	285,500
Annual IC Time Burden (Hours)	142,750	107,062	35,688
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.