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Submission for OMB Review; Comment Request for Reclearance of an Information Collection: SF 2809-1

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Office of Personnel Management.




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 reclearance of an information collection. SF 2809-1, Annuitant/OWCP Health Benefits Election Form, is used by annuitants of Federal retirement systems other than the Civil Service Retirement System (CSRS) and the Federal Employees Retirement System (FERS), including the Foreign Service Retirement System and the Office of Workers' Compensation Programs (OWCP) and certain former dependents of these individuals. These include former spouses who are eligible for enrollment under the Spouse Equity Act of 1984 (Pub. L. 98-615) and certain former dependents who are eligible for enrollment under the Temporary Continuation of Coverage (TCC) provisions of Federal Employees Health Benefits (FEHB) law (5 U.S.C. 8905a).

Approximately 9,000 SF 2809-1 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 (202) 606-8358, FAX (202) 418-3251 or e-mail to Please be sure to include a mailing address with your request.


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


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.

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Cyrus S. Benson, Team Leader, Budget and Administrative Services Division, Desktop Publishing and Printing Team, (202) 606-0623.

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Office of Personnel Management.

Kay Coles James,


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[FR Doc. 02-16952 Filed 7-5-02; 8:45 am]