Instructions For Request To Change Fehb Enrollment Or To Receive Plan Brochures For Spouse Equity And Temporary Continuation Of Coverage Enrollees

INSTRUCTIONS FOR REQUEST TO CHANGE FEHB ENROLLMENT OR TO RECEIVE PLAN BROCHURES FOR SPOUSE EQUITY AND TEMPORARY CONTINUATION OF COVERAGE ENROLLEES

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0202 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:	INSTRUCTIONS FOR REQUEST TO CHANGE FEHB ENROLLMENT OR TO RECEIVE PLAN BROCHURES FOR SPOUSE EQUITY AND TEMPORARY CONTINUATION OF COVERAGE ENROLLEES	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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DPRS 2809				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	2,500	2,500
Annual IC Cost Burden (Dollars)	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.