[Federal Register Volume 69, Number 42 (Wednesday, March 3, 2004)]
[Notices]
[Pages 10075-10076]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-4735]


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OFFICE OF PERSONNEL MANAGEMENT


Proposed Collection; Comment Request for the Extension of a 
Currently Approved Information Collection, SF 2809

AGENCY: Office of Personnel Management.

ACTION: Notice.

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SUMMARY: In accordance with the Paperwork Reduction Act of 1995 (Pub. 
L. 104-13, May 22, 1995), this notice announces that the Office of 
Personnel Management (OPM) intends to submit to the Office of 
Management and Budget (OMB) a request for the extension of a currently 
approved information collection. SF 2809, Employee 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 Federal Employees Health 
Benefits (FEHB) Program. Certain former spouses who are eligible for 
enrollment under the Spouse Equity Act of 1984 (Pub. L. 98-615), and 
former employees and former dependents who are eligible for enrollment 
under the Temporary Continuation of Coverage (TCC)

[[Page 10076]]

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: whether this information is 
necessary for the proper performance of functions of the Office of 
Personnel Management, and whether it will have practical utility; 
whether our estimate of the public burden of this collection of 
information is accurate, and based on valid assumptions and 
methodology; and ways in which we can minimize the burden of the 
collection of information on those who are to respond, through the use 
of appropriate technological collection techniques or other forms of 
information technology.
    For copies of this proposal, contact Mary Beth Smith-Toomey on 
(202) 606-2150, or E-mail to [email protected]. Please include a mailing 
address with your request.

DATES: Comments on this proposal should be received within 60 calendar 
days from the date of this publication.

ADDRESSES: Send or deliver comments to: Frank D. Titus, Assistant 
Director, Insurance Services Programs, Center for Retirement & 
Insurance Services, U.S. Office of Personnel Management, 1900 E Street, 
NW., Room 3400, Washington, DC 20415.
    For Information Regarding Administrative Coordination Contact: 
Cyrus S. Benson, Team Leader, Publications Team, Administrative 
Services Branch, (202) 606-0623.

U.S. Office of Personnel Management.
Kay Coles James,
Director.
[FR Doc. 04-4735 Filed 3-2-04; 8:45 am]
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