Information Collection Request
OPM 2809, Health Benefits Election Form
ICR 202304-3206-001 · OMB 3206-0141 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form OPM 2809 Health Benefits Election Form |
Form and Instruction | Modified | Available |
 OPM2809_30DayFRNPublished_2023_04_03.doc.pdf |
Supplementary Document | Uploaded 2023-04-21 | Repair queued |
| OPM2809_60DayFRNPublished_2023_02_06.pdf |
Supplementary Document | Uploaded 2023-04-21 | Repair queued |
| E8-5659.pdf |
Supplementary Document | Uploaded 2023-04-21 | Repair queued |
 OPM2809_OMBSupportingStatement_2023_final.docx |
Supporting Statement A | Uploaded 2023-04-21 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 33609 |  Health Benefits Election Form |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | OPM |
| OMB Control No | 3206-0141 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202003-3206-002 |
| Agency Tracking No | OPM 2809, Health Benefits Election Form |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |