Submission for OMB Review; Comment Request for Revision of Information Collection; SF 2809

Streszczenie

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 will submit to the Office of Management and Budget a request for reclearance of the following information collection. SF 2809, Health Benefits Registration Form, is used by annuitants under Federal retirement systems other than the Civil Service Retirement System and the Federal Employees Retirement System and by the former spouses of Federal employees and annuitants to register for and change enrollment in the Federal Employees Health Benefits Program. SF 2809 is needed to verify entitlement and to effect premium withholdings. Approximately 9,000 SF 2809 forms will be processed each year from former spouses and annuitants from other retirement systems. Each form takes approximately 30 minutes to complete. The annual estimated burden is 4,500 hours. For copies of this proposal, contact Jim Farron on (202) 418-3208, or E-mail to [email protected]