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Comment Request for Review of a Revised Information Collection: Multi-State Plan Program External Review Case Intake Form, OPM Form 1840

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Office of Personnel Management.




The Office of Personnel Management (OPM) intends to submit to the Office of Management and Budget (OMB) a request for review of a revision of a currently approved collection, the Multi-State Plan Program External Review Intake Form, OPM Form 1840. Approval of the revised Multi-State Plan Start Printed Page 12144Program External Review Intake Form is necessary to improve the collection of information from members of the Multi-State Plan Program who need to request the external review of a disputed adverse benefit decision.


Comments due by May 1, 2017.


Send or deliver comments to: Donna Lease Batdorf, Multi-State Plan Program National Healthcare Operations, Healthcare and Insurance, Office of Personnel Management, 1900 E Street NW., Room 3468, Washington, DC 20415.

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FOR INFORMATION REGARDING ADMINISTRATIVE COORDINATION CONTACT: For copies of this proposal, contact C.C. “Corky” Conyers, Ph.D., C.I.O. P.R.A./Forms Officer at (202) 606-0125, or via email to Please include a mailing address with your request.

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As required by the Paperwork Reduction Act of 1995 (Pub. L. 104-13, May 22, 1995), as amended by the Clinger-Cohen Act (Pub. L. 104-106), OPM is soliciting comments for this collection. The previous collection (OMB No. 3206-0263) was published in the Federal Register on November 26, 2013 at 78 FR 70598. Comments are particularly invited on:

1. Whether this collection of information is necessary for the proper performance of functions of the Office of Personnel Management, and whether it will have practical utility;

2. Whether our estimate of the public burden of this collection is accurate, and based on valid assumptions and methodology; and

3. Ways in which we can minimize the burden of the collection of information on those who are to respond, through the use of the appropriate technological collection techniques or other forms of information technology.


Agency: Multi-State Plan Program, National Healthcare Operations, Healthcare and Insurance, Office of Personnel Management.

Title: External Review Intake Form.

OMB: 3206-0263.


Affected Public: Individuals or Households.

Number of Respondents: 800.

Estimated Time Per Respondent: 60 minutes.

Total Burden Hours: 800 hours.

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Kathleen M. McGettigan,

Acting Director, U.S. Office of Personnel Management.

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[FR Doc. 2017-03869 Filed 2-27-17; 8:45 am]