02-16950. Submission for OMB Review; Comment Request for Reclearance of an Information Collection: SF 2809

AGENCY:

Office of Personnel Management.

ACTION:

Notice.

SUMMARY:

In accordance with the Paperwork Reduction Act of 1995 (Public Law 104-13, May 22, 1995 and 5 CFR 1320), this notice announces that the Office of Personnel Management (OPM) has submitted to the Office of Management and Budget (OMB) a request for reclearance of an information collection. SF 2809, Employee Health Benefits Election Form, is used by Federal employees to enroll for health insurance coverage under the Federal Employees Health Benefits (FEHB) Program. Certain former spouses of Federal employees, who are eligible for enrollment under the Spouse Equity Act of 1984 (P.L. 98-615), and former employees and former dependents who are eligible for enrollment under the Temporary Continuation of Coverage (TCC) 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.

For copies of this proposal, contact Mary Beth Smith-Toomey on [phone], FAX [phone] or e-mail to [e-mail]. Please be sure to include a mailing address with your request.

DATES:

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

ADDRESSES:

Send or deliver comments to—

Abby L. Block, Assistant Director, Office of Insurance Programs, Retirement and Insurance Service, U.S. Office of Personnel Management, 1900 E Street, NW, Room 3400, Washington, DC 20415-3600, and

Joseph Lackey, OPM Desk Officer, Office of Information & Regulatory Affairs, Office of Management and Budget, New Executive Office Building, NW, Room 10235, Washington, DC 20503.

FOR INFORMATION REGARDING ADMINISTRATIVE COORDINATION CONTACT:

Cyrus S. Benson, Team Leader, Budget and Administrative Services Division, Desktop Publishing and Printing Team, [phone].

Office of Personnel Management.

Kay Coles James,

Director.