[Federal Register Volume 69, Number 128 (Tuesday, July 6, 2004)]
[Notices]
[Page 40688]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-15133]


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OFFICE OF PERSONNEL MANAGEMENT


Submission for OMB Review; Comment Request for the Review of a 
Revised 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) has submitted to the Office of Management 
and Budget (OMB) a request for the review of a revised information 
collection. SF 2809, Health Benefits Election Form, is used by Federal 
employees, annuitants other than those under the Civil Service 
Retirement System (CSRS) and the Federal Employees Retirement System 
(FERS) [including individuals receiving benefits from the Office of 
Workers' Compensation Programs], former spouses eligible for benefits 
under the Spouse Equity Act of 1984, and separated employees and former 
dependents eligible to enroll under the Temporary Continuation of 
Coverage provisions of the FEHB law (5 U.S.C. 8905a). A different form 
(OPM 2809) is used by CSRS and FERS annuitants whose health benefit 
enrollments are administered by OPM's Retirement Services Program.
    Approximately 18,000 SF 2809 forms are completed annually. Each 
form takes approximately 30 minutes to complete. The annual estimated 
burden is 9,000 hours.
    For copies of this proposal, contact Mary Beth Smith-Toomey on 
(202) 606-8358, or e-mail to [email protected]. Please include your 
mailing address with your request. This proposal is not available 
electronically.

DATES: Comments on this proposal should be received within 30 calendar 
days from the date of this publication.

ADDRESSES: Send or deliver comments to--Frank D. Titus, Assistant 
Director, Insurance Services Program, Center for Retirement & Insurance 
Services, U.S. Office of Personnel Management, 1900 E Street, NW., Room 
3400, Washington, DC 20415; and Joseph F. Lackey, OPM Desk Officer, 
Office of Information and Regulatory Affairs, New Executive Office 
Building, NW., Room 10235, Washington, DC 20503.

For Information Regarding Administrative Coordination--Contact: Cyrus 
S. Benson, Team Leader, RIS Support Services/Support Group, 
Publications Team, (202) 606-0623.

    Office of Personnel Management.
Kay Coles James,
Director.
[FR Doc. 04-15133 Filed 7-2-04; 8:45 am]
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