Approved for two
years. In its next submission, OPM shall either consolidate this
form with 3206-0160 or provide a justification as to why
consolidation is not appropriate.
Inventory as of this Action
Requested
Previously Approved
09/30/2004
09/30/2004
09/30/2002
9,000
0
9,000
4,500
0
4,500
0
0
0
The SF 2809-1 will be 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 (P.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....
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.