OMB control number
Request to Change FEHB Enrollment or to Receive Plan Brochures for Spouse Equity/Temporary Continuation of Coverage Enrollees/Direct Pay Annuitants
OMB 0505-0024 · USDA/OCFO.
OMB 0505-0024
The Direct Pay Remittance System (DPRS) 2809 is used by enrollees under the Spouse Equity and Temporary Continuation of Coverage provisions of FEHB law, and by annuitants who pay their premiums directly to the retirement system. During the annual FEHB open season, these enrollees use this form to change their enrollment.
The latest form for Request to Change FEHB Enrollment or to Receive Plan Brochures for Spouse Equity/Temporary Continuation of Coverage Enrollees/Direct Pay Annuitants expires 2021-10-31 and is listed under ICR 201809-0505-001.
Latest Forms, Documents, and Supporting Material
| Document | 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 |
 0505-0024 - DPRS2809 SuppStmt - 2021.docx | Supporting Statement A |
 Request to Change FEHB Enrollment or to Receive Plan Brochures for Spouse Equity/Temporary Continuation of Coverage Enrollees/Direct Pay Annuitants |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202109-0505-002 | Revision of a currently approved collection | 2021-10-29 | Approved with change | |
| 201809-0505-001 | Reinstatement without change of a previously approved collection | 2018-09-12 | Approved without change | |
| 201409-0505-001 | Extension without change of a currently approved collection | 2014-10-30 | Approved with change | |
| 201206-0505-001 | Revision of a currently approved collection | 2012-06-13 | Approved with change |