Federal Employees Dental and Vision Insurance Program (FEDVIP)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
30 Day Notice 3206-0272.pdf	Supplementary Document	Uploaded 2019-06-13	Available
3206 0272 60 DAY Notice.pdf	Supplementary Document	Uploaded 2019-05-28	Available
3206-0272 Supporting Statement 04 23 2019.doc	Supporting Statement A	Uploaded 2019-05-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
233779	FED VIP (BENFEDS.com)		Modified

ICR Details

OMB Control No: 3206-0272	ICR Reference No: 201905-3206-005
Status: Active	Previous ICR Reference No: 201811-3206-002
Agency/Subagency: OPM	Agency Tracking No:
Title: Federal Employees Dental and Vision Insurance Program (FEDVIP)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/14/2019
	Date Received in OIRA: 05/31/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2022	36 Months From Approved	09/30/2019
Responses	332,304	0	332,304
Time Burden (Hours)	44,307	0	44,307
Cost Burden (Dollars)	158,988	0	0

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Abstract: The Federal Employees Dental and Vision Insurance Program Enrollment System uses BENEFEDS, which is the secure enrollment website sponsored by OPM that allows eligible individuals to enroll or change enrollment in a FEDVIP plan. Eligible individuals use the system to enroll or change enrollment during the annual Open Season or when experiencing a qualifying life event under 5 CFR 894.101. Federal Civilian and U.S. Postal Service (USPS) employees, retirees (annuitants), survivor annuitants, compensationers, and their eligible family members can enroll and be enrolled in FEDVIP. In addition, most uniformed services retirees and their families will be eligible to enroll in dental and vision insurance and most uniformed services active duty family members will be eligible to enroll in vision insurance under FEDVIP.

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Authorizing Statute(s): US Code: 5 USC Chapters 89A and 89B Name of Law: Section 715 of Pub. L. 114-328
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
3206-AN58	Final or interim final rulemaking	84 FR 26543	06/07/2019

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 9816	03/12/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 26171	06/05/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
FED VIP (BENFEDS.com)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	332,304	332,304	0	0	0	0
Annual Time Burden (Hours)	44,307	44,307	0	0	0	0
Annual Cost Burden (Dollars)	158,988	0	0	158,988	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $158,987

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 05/31/2019

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