View Information Collection Request (ICR) Package

OMB Control No: 3206-0202	ICR Reference No: 200102-3206-001
Status: Historical Active	Previous ICR Reference No: 199507-3206-001
Agency/Subagency: OPM	Agency Tracking No:
Title: Request to Change FEHB Enrollment or to receive Plan brochures for Spouse Equity and Temporary Continuation of Coverage Enrollees
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/29/2001
	Date Received in OIRA: 02/15/2001
Terms of Clearance: This request--as modified by submissions of additional supporting material and changes described to the form and instructions is approved. Those sumbissions of additional material are as follows: 1. Message from Cyrus Benson to Dan LaPlaca dated 5/11/01. 2. Message from Daniel Green to Dan LaPlaca dated 6/4/01. 3. Message from M. B.Smith Toomie to J. Lackey dated 8/15/01. 4. Message from M. B.Smith-Toomie to J. Lackey dated 8/27/01. All of the above referenced messages were transmitted to OMB by e-mail.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2004	08/31/2004
Responses	1,400	0	0
Time Burden (Hours)	20,250	0	0
Cost Burden (Dollars)	0	0	0

Abstract: DPRS-2809 is used by annuitants and former spouses who are eligible to elect, cancel, 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

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Request to Change FEHB Enrollment or to receive Plan brochures for Spouse Equity and Temporary Continuation of Coverage Enrollees	DPRS-2809

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	1,400	1,400
Annual Time Burden (Hours)	20,250	20,250
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

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