View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 3206-0141	ICR Reference No: 200904-3206-009
Status: Historical Active	Previous ICR Reference No: 200508-3206-003
Agency/Subagency: OPM	Agency Tracking No:
Title: Health Benefits Election Form
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: 06/02/2009
	Date Received in OIRA: 04/30/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2012	36 Months From Approved
Responses	30,000	0	0
Time Burden (Hours)	16,667	0	0
Cost Burden (Dollars)	0	0	0

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