Opm form 2809 revised july 2020-2026

1. Click ‘Get Form’ to open the opm form 2809 in the editor.
2. Begin with Part A, where you will enter your personal information including your name, Social Security Number, and date of birth. Ensure all details are accurate.
3. In item 5, indicate your marital status and provide your home address in item 6. If applicable, check if you are covered by Medicare in items 7 and 8.
4. Complete the family member information for each eligible family member under Part A. Include their names, Social Security Numbers, and relationship codes.
5. Move to Part B to specify the FEHB plan you are currently enrolled in. Enter the plan name and enrollment code.
6. In Part C, fill out the details of the new FEHB plan you wish to enroll in or change to, including its name and enrollment code.
7. If applicable, complete Parts D through G based on your situation—whether enrolling, canceling, or suspending coverage.
8. Finally, sign and date the form in Part H to authorize processing. Review all entries for accuracy before submission.

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