Dprs 2809 Ss

OMB SUPPORTING STATEMENT

DPRS-2809 – Request to Change FEHB Enrollment

1. Justification

1. Title 5, U.S. Code, Chapter 89, sections 8905 and 8905a specifies the opportunities and conditions under which a retiree, survivor annuitant, separated employee, former spouse or former dependent child of a retiree, employee, or separated employee is eligible to change enrollment in the Federal Employees Health Benefits (FEHB) Program. DPRS-2809 is completed by the enrollee to make an open season enrollment change. It may also be used to request brochures that describe FEHB plans the enrollee wishes to consider for enrollment during the coming year.

2. The DPRS-2809 is administered by the U.S. Department of Agriculture's National Finance Center (NFC) for use by separated employees or former spouses and former dependent children of active or separated employees. NFC determines whether all conditions permitting change in enrollment are met and implements the enrollment change. NFC also informs the health benefits carriers of the action. If this information were not collected, NFC could not comply with the provisions of title 5, U.S. Code, Chapter 89.

3. Improved technology has been used in the construction and processing of DPRS-2809; the form is a computer-generated mailer. However, there is no improved technology to reduce the burden on the respondent. The information collected can only be obtained from the respondents; they must sign the election form to signify their desire for the enrollment of enrollment change.

4. This form is filed individually. Duplication is minimized. Up-to-date similar information is not available.

5. This information collection does not involve small businesses.

6. This information is collected because during open season an enrollee may change enrollment in the FEHB Program. The frequency of collection is determined by the provisions of title 5, U.S. Code, Chapter 89.

7. This information collection is consistent with the guidelines in 5 CFR 1320.6.

8. Notice of the information collection was published in the Federal Register on July 9, 2007, giving persons outside the agency an opportunity to comment on the form. No comments were received.

9. No payment or gift is provided to these respondents.

10. The information collection is protected by the Privacy Act of 1974 and OPM regulations (5 CFR 831.106). The routine uses of disclosure appear in the Federal Register for OPM/Central-1 (73 FR 15013, et seq., March 20, 2008).

11. This information collection does not include questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private.

12. There are approximately 27,000 respondents to the DPRS-2809 per year. The annual hour burden is estimated to be 20,250 hours. The hour burden was determined by multiplying the number of possible respondents by the estimated time it takes for a respondent to complete the form (45 minutes or .75 of one hour).

13. There is no cost to the respondents.

14. The total annual cost to the Federal Government is estimated to be $16,000. Approximately $8,900 will be spent on postage; $2,100 will be spent on materials, such as paper and envelopes; and $5000 will be spent on other operations, such as programming and testing.

15. There are no changes to the respondent’s burden.

16. The results of this information collection are not published.

17. It is not cost-effective to reprint the whole supply of forms to change the OMB clearance expiration date. Therefore, we seek approval not to display the date on the form.

18. There are no exceptions to the certification statement.