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OMB Control No: 3206-0202	ICR Reference No: 199109-3206-001
Status: Historical Active	Previous ICR Reference No: 199108-3206-001
Agency/Subagency: OPM	Agency Tracking No:
Title: INSTRUCTIONS FOR REQUEST TO CHANGE FEHB ENROLLMENT OR TO RECEIVE PLAN BROCHURES FOR SPOUSE EQUITY AND TEMPORARY CONTINUATION OF COVERAGE ENROLLEES
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: 09/18/1991
	Date Received in OIRA: 09/12/1991
Terms of Clearance: 1. By this action, OMB approves the instructions to DPRS Form 2809 so that both the form and the instructions are assisgned this OMB control number. 2. Approval for both the form and instructions will expire on 8/31/92 since by nature of the program, content of the information collection changes anually. 3. In the future, any request such as this to amend an existing approval action, should include all material the agency intends to be approved under the control number assigned. OPM's failure to do so may result in delays in consideration of its request for OMB approval.

Abstract: DPRS FORM 2809 IS USED BY INDIVIDUALS WHO ARE ELIGIBLE TO ELECT, CANCE OR CHANGE HEALTH BENEFITS ENROLLMENT DURING OPEN SEASON.

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	15,000	15,000
Annual Time Burden (Hours)	2,500	2,500
Annual Cost Burden (Dollars)	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:

Annual Cost to Federal Government: $0

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

View ICR - OIRA Conclusion