THIS FORM IS USED ONLY AT OPEN SEASON
TO REQUEST AN ENROLLMENT CHANGE, INSURANCE PLAN BROCHURES, AND
OTHER INFORMATIONAL MATERIALS. IF OPM FORM 2809-EZ1 IS USED TO
REQUEST PLAN BROCHURES, AN OPM FORM 2809-EZ2 FURNISHED THE ENROLLEE
FOR USE IF A PLAN CHANGE IS DESIRED. IT IS COMPLETED BY RETIREES,
SURVIVOR ANNUITANTS, AND FORMER SPOUSES OF RETIREES.
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.