Information Collection

Health Benefits Registration Form To Change Fehb Enrollment Or To Receive Plan Brochures For..

IC 156942 under ICR 199107-3206-001 · OMB 3206-0141.

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Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

HEALTH BENEFITS REGISTRATION FORM TO CHANGE FEHB ENROLLMENT OR TO RECEIVE PLAN BROCHURES FOR..

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OPM 2809				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 34,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	34,800	-260,700	295,500
Annual IC Time Burden (Hours)	17,400	-130,350	147,750
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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