# Submission for Review: Health Benefits Registration Form, OPM 2809
**AGENCY:**
U.S. Office of Personnel Management.
**ACTION:**
30-Day Notice and request for comments.
**SUMMARY:**
The Retirement Services, Office of Personnel Management (OPM) offers the general public and other federal agencies the opportunity to comment on an existing information collection request (ICR) 3206-0141, Health Benefits Election Form, OPM 2809. As required by the Paperwork Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. chapter 35), as amended by the Clinger-Cohen Act (Pub. L. 104-106), OPM is soliciting comments for this collection. This information collection was previously published in the *Federal Register* on June 7, 2011 at volume 76 FR 32996 allowing for a 60 day public comment period. We received comments from one organization. A response was sent to the organization. The purpose of this notice is to allow an additional 30 days for public comments. The Office of Management and Budget is particularly interested in comments that:
1. Evaluate whether the proposed collection of information is necessary for the proper performance of functions of the agency, including whether the information will have practical utility;
2. Evaluate the accuracy of the agency's estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used;
3. Enhance the quality, utility, and clarity of the information to be collected; and
4. Minimize the burden of the collection of information on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submissions of responses.
**DATES:**
Comments are encouraged and will be accepted until January 30, 2012. This process is conducted in accordance with 5 CFR 1320.1.
**ADDRESSES:**
Interested persons are invited to submit written comments on the proposed information collection to the Office of Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street NW., Washington, DC 20503, Attention: Desk Officer for the Office of Personnel Management or sent via electronic mail to *[email protected]* or faxed to (202) 395-6974.
**FOR FURTHER INFORMATION CONTACT:**
A copy of this ICR with applicable supporting documentation may be obtained by contacting the Office of Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street NW., Washington, DC 20503, Attention: Desk Officer for the Office of Personnel Management or sent via electronic mail to *[email protected]* or faxed to (202) 395-6974.
**SUPPLEMENTARY INFORMATION:**
OPM Form 2809, Health Benefits Election Form, is used by annuitants and former spouses to elect, cancel, suspend, or change health benefits enrollment during periods other than open season.
**Analysis**
*Agency:* Retirement Operations, Retirement Services, Office of Personnel Management.
*Title:* Health Benefits Election Form.
*OMB Number:* 3206-0141.
*Frequency:* On occasion.
*Affected Public:* Individuals or households.
*Number of Respondents:* 30,000.
*Estimated Time per Respondent:* 45 minutes.
*Total Burden Hours:* 16,667 hours.
U.S. Office of Personnel Management.
John Berry,
Director.