OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Request to Change FEHB Enrollment or to Receive Plan Brochures for Spouse Equity/Temporary Continuation of Coverage Enrollees/Direct Pay Annuitants

IC 33692 under ICR 201108-3206-002 · OMB 3206-0202.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form DPRS 2809
Request to Change FEHB Enrollment or to Receive Plan Brochures for Spouse Equity/Temporary Continuation of Coverage Enrollees/Direct Pay Annuitants		 Form and Instruction
DPRS 2809 Request to Change FEHB or to Receive Plan Brochures for
DPRS 2809.pdf 		Form and Instruction
2008 Markups.pdf
2008 Markups		IC Document
2011 Markups.pdf
2011 Markups		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 and Instruction DPRS 2809 Request to Change FEHB or to Receive Plan Brochures for Spouse Equity/Temporary Continuation of Coverage Enrollees/Direct Pay Annuitant DPRS 2809.pdf Yes No Fillable Printable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 27,000 0 0 0 0 27,000
Annual IC Time Burden (Hours) 20,250 0 0 0 0 20,250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
2008 Markups 2008 Markups.pdf 08/18/2011
2011 Markups 2011 Markups.pdf 08/18/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.