Notice of Request for Reclearance of OPM Form 2809

OFFICE OF PERSONNEL MANAGEMENT

Notice of Request for Reclearance of OPM Form 2809

AGENCY: Office of Personnel Management.

[[Page 28183]] ACTION: Notice.

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SUMMARY: In accordance with the Paperwork Reduction Act of 1980 (title

44, U.S. Code, chapter 35), this notice announces a request for a

reclearance of an information collection. OPM Form 2809, Health

Benefits Registration Form, is used by annuitants and former spouses to

elect, cancel, or change health benefits enrollment during periods

other than open season.

Approximately 34,800 OPM Form 2809's are completed annually. We

estimate that it takes 45 minutes to fill out the form. The annual

burden is 26,100 hours.

For copies of this proposal, contact Doris R. Benz on (703) 908-

8464.

DATES: Comments on this proposal should be received on or before June

29, 1995.

ADDRESSES: Send or deliver comments to--

Lorraine E. Dettman, Retirement and Insurance Service, Operations

Support Division, U.S. Office of Personnel Management, 1900 E. Street,

NW, Room 3349, Washington, DC 20415

and

Joseph Lackey, OPM Desk Officer, Office of Information and Regulatory

Affairs, Office of Management and Budget, New Executive Office

Building, NW, Room 10235, Washington, DC 20503.

FOR INFORMATION REGARDING ADMINISTRATIVE COORDINATION--CONTACT: Mary

Beth Smith-Toomey, Team Leader, Forms Analysis and Design (202) 606-

0623.

U.S. Office of Personnel Management.

Lorraine A. Green,

Deputy Director.

[FR Doc. 95-13057 Filed 5-26-95; 8:45 am]

BILLING CODE 6325-01-M