Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement informs you of why the Office of Personnel Management (OPM), the Annuitants Health Benefit Online Support System (AHBOSS) is requesting the information on this application. Authority: OPM is authorized to collect the information requested via AHBOSS pursuant to Title 5, U.S. Code § 3301 Chapter 89, Sections 8905 and 8905a. The Civil Service Retirement System (CSRS) is administered pursuant to 5 U.S.C. chapter 83, and the Federal Employees Retirement System (FERS) is administered pursuant to 5 U.S.C. chapter 84. The Federal Employees Health Benefits (FEHB) Open Season is administered pursuant to 48 U.S.C. chapter 16 and 5 C.F.R chapter 890. In addition, the following authorities are relevant to the information in AHBOSS: chapters 87 and 90; Pub. L. 83-598, 84- 356, 86-724, 94-455, and 106-265; and Executive Order 9397, as amended by Executive Order 13478. OPM is authorized to collect your Social Security Number pursuant to the aforementioned authorities. Purpose: The information collected is used to verify entitlement and initiate an FEHB enrollment change for the upcoming year or to request FEHB information. OPM will use this information to allow open season changes and to allow customers to view health benefit plan brochures. The customer’s Social Security number is used as a part of the identifying information in the record. Routine Uses: The information requested on this form may be shared externally as a “routine use” to the health insurance carrier you selected so that they may (1) identify your enrollment in the plan, (2) verify your and/or your family’s eligibility for payment of claims for health benefits services or supplies, and (3) coordinate payment of claims with other carriers with whom you might also make a claim for payment of benefits. This information may be disclosed to other Federal agencies or Congressional offices that may have a need to know in connection with your application for a job, license, grant, or other benefits. It may also be shared and is subject to verification via paper, electronic media, or through the use of computer matching programs, with national, state, local, or other charitable or Social Security administrative agencies to determine and issue benefits under this program. In addition, to the extent this information indicates a possible violation of civil or criminal law, it may be shared and verified, as noted above, with an appropriate Federal, state, or local law enforcement agency. A complete list of the routine uses can be found in the system of records notice associated with this information collection request (ICR), OPM/Central–1 Civil Service Retirement and Insurance Records,73 FR 15013 (March 20, 2008); Modification 80 FR 74815 (November 30, 2015) and OPM/Central-23 FEHB Program Enrollment Records, 86 FR 6377 (January 21,2021). Disclosure: Providing this information to OPM via AHBOSS is voluntary. However, failure to provide this information may result in your being unable to make changes to your coverage here. You may instead use the Interactive Voice Response (IVR) system or the Open Season Call Center at (800)-332-9798 to speak to customer service representatives who can assist you in making open season changes.
We estimate providing this information takes an average of 10 minutes per response to complete,
including the time for reviewing instructions, getting the needed data, and reviewing the completed
responses. Send comments regarding our estimate including suggestions for reducing completion time,
to the U.S. Office of Personnel Management (OPM), Retirement Services Publications Team (3206-0201),
Washington, D.C. 20415-0001. OPM may not collect this information, and you are not required to respond,
unless this number is displayed.
This notice is reviewed annually for updates.
[Last Update: Aug. 11, 2021]