The information you provide is needed for your enrollment in the Federal Health Benefits
Program authorized by Title 5, U.S. Code, Chapter 89, Sections 8905 and 8905a. This information
will be shared with the health insurance carrier you select, so that they may (1) identify your
enrollment in the plan, (2) verify you 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 need to know in connection
with your application for a job, license, grant or other benefit. 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. While the law does not
require you to supply all the information requested, doing so will assist in the prompt processing
of your enrollment. A complete list of routine uses can be found in the system of records notice
associated with this information collection request (ICR), OPM/Central-1, 73 FR 15013
An annuitant may access his or her own Personally Identifiable Information (PII) by logging in to the AHBOSS web system. The PII entered into AHBOSS is restricted in AHBOSS using federal government standards (National Institute of Standards and Technology Special Publications 800-53 Rev. 4).
We think this collection of information takes an average of 10 minutes to complete, including the time for
reviewing instructions and getting the needed data. Send the comments regarding our estimate or any other
aspect of this information collection request (ICR), including suggestions for reducing completion time,
to the Office of Personnel Management, Retirement Services Publications Team (3206-0201), Washington, DC 20415-0001.
The OMB number, 3206-0201, is currently valid. 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: Sept. 25, 2017]