SF 2809 Federal Employees Health Benefits Program Election Form; OPM 2809 Health Benefits Election Form

ICR 202504-3206-001

OMB: 3206-0160

Federal Form Document

Forms and Documents

Document Name	Status
Form SF 2809 Health Benefits Election Form Form and Instruction	Unchanged
Form SF 2809 Health Benefits Election Form Form and Instruction	Unchanged
Non-Substantive_Change_Request_HB_Election_Forms_2025.docx Justification for No Material/Nonsubstantive Change	2025-04-02
Non-Substantive_Change_Request_HB_Election_Forms_2025.docx Justification for No Material/Nonsubstantive Change	2025-04-02
Health Benefit Election Forms (Supporting Statement Part A)_final.docx Supporting Statement A	2024-11-12
Health Benefit Election Forms (Supporting Statement Part A)_final.docx Supporting Statement A	2024-11-12
E8-5659.pdf Supplementary Document	2022-04-28
E8-5659.pdf Supplementary Document	2022-04-28
Citations for SF 2809.pdf Supplementary Document	2022-04-28
Citations for SF 2809.pdf Supplementary Document	2022-04-28

IC Document Collections

IC ID	Document Title	Status
33632	Health Benefits Election Form Form and Instruction	Unchanged
33632	Health Benefits Election Form Form and Instruction	Unchanged