FEHB IVR Open Seas Web page 2

Privacy Act Statement
Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement informs you of why the Office
of Personnel Management (OPM), the Annuitants Health Benefit Online Support System
(AHBOSS) is requesting the information on this application. Authority: OPM is authorized
to collect the information requested via AHBOSS pursuant to Title 5, U.S. Code § 3301
Chapter 89, Sections 8905 and 8905a. The Civil Service Retirement System (CSRS) is
administered pursuant to 5 U.S.C. chapter 83, and the Federal Employees Retirement
System (FERS) is administered pursuant to 5 U.S.C. chapter 84. The Federal Employees
Health Benefits (FEHB) Open Season is administered pursuant to 48 U.S.C. chapter 16 and 5
C.F.R chapter 890. In addition, the following authorities are relevant to the information in
AHBOSS: chapters 87 and 90; Pub. L. 83-598, 84- 356, 86-724, 94-455, and 106-265; and
Executive Order 9397, as amended by Executive Order 13478. OPM is authorized to collect
your Social Security Number pursuant to the aforementioned authorities. Purpose: The
information collected is used to verify entitlement and initiate an FEHB enrollment change
for the upcoming year or to request FEHB information. OPM will use this information to
allow open season changes and to allow customers to view health benefit plan brochures.
The customer’s Social Security number is used as a part of the identifying information in
the record. Routine Uses: The information requested on this form may be shared externally
as a “routine use” to the health insurance carrier you selected so that they may (1) identify
your enrollment in the plan, (2) verify your and/or your family’s eligibility for payment of
claims for health benefits services or supplies, and (3) coordinate payment of claims with
other carriers with whom you might also make a claim for payment of benefits. This
information may be disclosed to other Federal agencies or Congressional offices that may
have a need to know in connection with your application for a job, license, grant, or other
benefits. It may also be shared and is subject to verification via paper, electronic media, or
through the use of computer matching programs, with national, state, local, or other
charitable or Social Security administrative agencies to determine and issue benefits under
this program. In addition, to the extent this information indicates a possible violation of
civil or criminal law, it may be shared and verified, as noted above, with an appropriate
Federal, state, or local law enforcement agency. A complete list of the routine uses can be
found in the system of records notice associated with this information collection request
(ICR), OPM/Central–1 Civil Service Retirement and Insurance Records,73 FR 15013 (March
20, 2008); Modification 80 FR 74815 (November 30, 2015) and OPM/Central-23 FEHB
Program Enrollment Records, 86 FR 6377 (January 21,2021). Disclosure: Providing this
information to OPM via AHBOSS is voluntary. However, failure to provide this information
may result in your being unable to make changes to your coverage here. You may instead
use the Interactive Voice Response (IVR) system or the Open Season Call Center at (800)332-9798 to speak to customer service representatives who can assist you in making open
season changes.

Public Burden Statement
We estimate providing this information takes an average of 10 minutes per response to
complete, including the time for reviewing instructions, getting the needed data, and
reviewing the completed responses. Send comments regarding our estimate including
suggestions for reducing completion time, to the U.S. Office of Personnel Management
(OPM), Retirement Services Publications Team (3206-0201), Washington, D.C. 20415-0001.
OPM may not collect this information, and you are not required to respond, unless this
number is displayed.
This notice is reviewed annually for updates.
[Last Update: Aug. 11, 2021]