OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

SF 2809 Federal Employees Health Benefits Program Election Form; OPM 2809 Health Benefits Election Form

OMB 3206-0160 · OPM.

OMB 3206-0160

The SF 2809 is used to enroll, elect not to enroll, change, suspend or cancel your health insurance coverage in the Federal Employees Health Benefits (FEHB) Program which includes FEHB and Postal Service Health Benefits (PSHB) plans. A different form (OPM 2809) is used by annuitants retired under the Civil Service Retirement System (CSRS) or Federal Employees' Retirement System (FERS), electing or changing either there FEHB or Postal Service Health Benefit (PSHB) coverage under the FEHB Program as well as the following: children and former spouses who are eligible for temporary continuation of coverage; former spouses; survivor annuitants under CSRS or FERS; an OPM appointed representative payee or court appointed guardian of the eligible member.

The latest form for SF 2809 Federal Employees Health Benefits Program Election Form; OPM 2809 Health Benefits Election Form expires 2027-11-30 and is listed under ICR 202504-3206-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form OPM 2809 Health Benefits Election FormForm and Instruction
Form SF 2809 Federal Employees Health Benefits Program Election FormForm and Instruction
Form SF 2809 Health Benefits Election FormForm and Instruction
Non-Substantive_Change_Request_HB_Election_Forms_2025.docxJustification for No Material/Nonsubstantive Change
Non-Substantive_Change_Request_HB_Election_Forms_2025.docx Justification for No Material/Nonsubstantive Change
Health Benefit Election Forms (Supporting Statement Part A)_final.docxSupporting Statement A
Health Benefit Election Forms (Supporting Statement Part A)_final.docxSupporting Statement A
E8-5659.pdfSupplementary Document
E8-5659.pdf Supplementary Document
Citations for SF 2809.pdfSupplementary Document
Health Benefits Election Form Form and Instruction
Health Benefits Election Form Form and Instruction
Health Benefits Election Form Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202504-3206-001 No material or nonsubstantive change to a currently approved collection 2025-04-02 Approved without change
202410-3206-002 Revision of a currently approved collection 2024-10-11
202204-3206-001 Revision of a currently approved collection 2022-05-05 Approved with change
202203-3206-004 No material or nonsubstantive change to a currently approved collection 2022-03-07 Approved without change
201903-3206-002 Revision of a currently approved collection 2019-03-29 Approved with change
201510-3206-008 Revision of a currently approved collection 2015-10-30 Approved with change
201408-3206-004 Revision of a currently approved collection 2014-08-28 Approved without change
201106-3206-005 Revision of a currently approved collection 2011-06-22 Approved with change
200711-3206-003 Extension without change of a currently approved collection 2007-11-09 Approved without change
200406-3206-003 Revision of a currently approved collection 2004-06-30 Approved without change
200207-3206-001 Extension without change of a currently approved collection 2002-07-03 Approved without change
199901-3206-004 Revision of a currently approved collection 1999-01-29 Approved without change
199611-3206-002 Revision of a currently approved collection 1996-11-05 Approved without change
199306-3206-006 Revision of a currently approved collection 1993-06-03 Approved without change
199208-3206-003 No material or nonsubstantive change to a currently approved collection 1992-08-18 Approved with change
199207-3206-001 Revision of a currently approved collection 1992-07-27 Approved without change
199109-3206-004 Revision of a currently approved collection 1991-09-27 Approved without change
198808-3206-001 Revision of a currently approved collection 1988-08-26 Approved without change
198507-3206-005 New collection (Request for a new OMB Control Number) 1985-07-31 Approved without change