United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2004_register executive 2010-09-23 article Notices D09002ee1c815a88d D09002ee1c815a90b United States Office of Personnel Management originator org United States Government Agency or Subagency 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 mbtoomey@opm.gov. Please include your mailing address with your request. This proposal is not available electronically. 69 FR 40688 https://www.govinfo.gov/app/details/FR-2004-07-06/04-15133 04-15133 fr06jy04-87 6325-38-P https://www.govinfo.gov/app/details/FR-2004-07-06/04-15133 https://www.govinfo.gov/content/pkg/FR-2004-07-06/html/04-15133.htm https://www.govinfo.gov/content/pkg/FR-2004-07-06/pdf/04-15133.pdf 1 p. 40688 40688 69 FR 40688 Submission for OMB Review; Comment Request for the Review of a Revised Information Collection: SF 2809; Federal Register Vol. 69, Issue NOTICE 04-15133 OFFICE OF PERSONNEL MANAGEMENT 6325-38-P 04-15133 Notice.

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 mbtoomey@opm.gov. Please include your mailing address with your request. This proposal is not available electronically.

Comments on this proposal should be received within 30 calendar days from the date of this publication. Agency information collection activities; proposals, submissions, and approvals, mbtoomey@opm.gov Vol. 69, no. 128 Office of the Federal Register, National Archives and Records Administration 2004-07-06 continuing daily deposited born digital 243 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2004-07-06 P0b002ee18096f585 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr06jy04 https://www.govinfo.gov/app/details/FR-2004-07-06 https://www.govinfo.gov/content/pkg/FR-2004-07-06/pdf/FR-2004-07-06.pdf https://www.govinfo.gov/content/pkg/FR-2004-07-06/xml/FR-2004-07-06.xml fdlp 40533 40761 DGPO 2010-09-23 2024-06-06 FR-2004-07-06 machine generated eng FR FR-2004-07-06 69 128