Proposed Collection; Comment Request for Review of a Revised Information Collection SF 2809

Resumen

In accordance with the Paperwork Reduction Act of 1995 (Public Law 104-13, May 22, 1995), this notice announces that the Office of Personnel Management intends to submit to the Office of Management and Budget a request for review of a revised information collection. SF 2809, Federal Employees Health Benefits Election Form, is used by Federal employees, certain separated former Federal employees, and former dependents of Federal employees, to enroll for health insurance coverage under the FEHB Program. Certain former spouses or former Federal employees who are eligible for enrollment under the Spouse Equity Act of 1984 (Pub. L. 98-615), and former spouse employees and former dependents who are eligible for enrollment under the Temporary Continuation of Coverage (TCC) provisions of FEHB law (5 U.S.C. 8905a) also use this form. Approximately 9,000 SF 2809 forms are completed annually. Each form takes approximately 30 minutes to complete. The annual estimated burden is 4,500 hours. Comments are particularly invited on: