[Federal Register Volume 86, Number 208 (Monday, November 1, 2021)]
[Notices]
[Page 60304]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-23740]


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OFFICE OF PERSONNEL MANAGEMENT


Submission for Review: 3206-0160, Health Benefits Election Form, 
Standard Form 2809

AGENCY: Office of Personnel Management.

ACTION: 60-Day notice and request for comments.

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SUMMARY: Federal Employee Insurance Operations (FEIO), Healthcare & 
Insurance, Office of Personnel Management (OPM) offers the general 
public and other federal agencies the opportunity to comment on an 
expiring information collection request (ICR) without change, Health 
Benefits Election Form, Standard Form 2809.

DATES: Comments are encouraged and will be accepted until January 3, 
2022.

ADDRESSES: You may submit comments, identified by docket number and/or 
Regulatory Information Number (RIN) and title, by the following method:

--Federal Rulemaking Portal: http://www.regulations.gov. Follow the 
instructions for submitting comments.

    All submissions received must include the agency name and docket 
number or RIN for this document. The general policy for comments and 
other submissions from members of the public is to make these 
submissions available for public viewing at http://www.regulations.gov 
as they are received without change, including any personal identifiers 
or contact information.

FOR FURTHER INFORMATION CONTACT: A copy of this ICR with applicable 
supporting documentation, may be obtained by contacting the Retirement 
Services Publications Team, Office of Personnel Management, 1900 E 
Street NW, Room 3316-L, Washington, DC 20415, Attention: Cyrus S. 
Benson, or sent via electronic mail to [email protected] or faxed to 
(202) 606-0910 or via telephone at (202) 606-4808.

SUPPLEMENTARY INFORMATION: As required by the Paperwork Reduction Act 
of 1995 OPM is soliciting comments for this collection (OMB No. 3206-
0160). The Office of Management and Budget is particularly interested 
in comments that:
    1. Evaluate whether the proposed collection of information is 
necessary for the proper performance of functions of the agency, 
including whether the information will have practical utility;
    2. Evaluate the accuracy of the agency's estimate of the burden of 
the proposed collection of information, including the validity of the 
methodology and assumptions used;
    3. Enhance the quality, utility, and clarity of the information to 
be collected; and
    4. Minimize the burden of the collection of information on those 
who are to respond, including through the use of appropriate automated, 
electronic, mechanical, or other technological collection techniques or 
other forms of information technology, e.g., permitting electronic 
submissions of responses.
    Standard Form 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 Operations.

Analysis

    Agency: Federal Employee Insurance Operations, Healthcare & 
Insurance, Office of Personnel Management.
    Title: Health Benefits Election Form.
    OMB Number: 3206-0160.
    Frequency: On occasion.
    Affected Public: Individuals or Households.
    Number of Respondents: 18,000.
    Estimated Time per Respondent: 30 minutes.
    Total Burden Hours: 9,000.

Office of Personnel Management.
Kellie Cosgrove Riley,
Director, Office of Privacy and Information Management.
[FR Doc. 2021-23740 Filed 10-29-21; 8:45 am]
BILLING CODE 6325-38-P