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Viewing a 2809 Record

The View function allows users to view 2809 records.

To View a 2809 Record:

  1. Select the Forms tab on the CLER Main Menu.

    Forms Main Page

  2. Select the 2809 option at the top on the Form Main page. The Form 2809 page is displayed.

    Form 2809 page

  3. Complete the following fields on the Form 2809 page:

    Payroll Office ID

    Year

    Quarter

    Agency ID

    POI

    Enrollment Code

    SSN

    User ID

    Last Name

    First Name

    Initial

    Display

    Order By

  4. Select the Submit button to confirm all data entered. The Form 2809 search results page is displayed.

    OR

    Select the Reset button to clear all data entered.

    Form 2809 search results page

    The data on the Form 2809 search results page is categorized into the following fields:

    Payroll Office ID

    Year/Quarter

    Enrollee SSN

    Last Name

    First Name

    Release Date

    Released By

    Status

    Options

  5. Select the View button next to the applicable record. The Form 2809 View (Part A) page is displayed.

    Form 2809 View Part A

    The data on the Form 2809 View page is categorized into the following fields:

    Payroll Office ID

    Year

    Quarter

    Personnel Office ID

    Nature of Action

    The data on the Form 2809 View Part A is categorized into the following fields:

    Last Name

    First Name

    Initial

    Address Line 1

    Address Line 2

    Address Line 3

    City

    State

    Zip

    Foreign Country

    SSN

    Date of Birth

    Sex

    Married

    Other Insurance

    Policyholder Last Name

    Policyholder First Name

    Policyholder Initial

    Medicare You

    Medicare Spouse

    TRICARE/CHAMPUS

    Other

    Name

    Last Changed ID

    Last Changed Date

    Last Changed Time

    Released ID

    Released Date

    Released Time

    Processed Date

    Processed Time

  6. Select the Part A Continued option. The Form 2809 View Part A Continued is displayed.

    Form 2809 View Part A Continued

    The data on the Form 2809 View Part A Continued is categorized into the following fields:

    Last Name

    First Name

    Initial

    Date of Birth

    Code

    SSN

    Sex

    Zip

  7. Select the Parts B through H option to display the Form 2809 View (Parts B through H) page.

    Form 2809 View Page Part B H

    The data on the Form 2809 View Part B is categorized into the following fields:

    Present Plan Name

    Present Enrollment Code

    The data on the Form 2809 View Part C is categorized into the following fields:

    New Plan Name

    New Enrollment Code

    The data on the Form 2809 View Part D is categorized into the following fields:

    Event That Permits Change

    Date

    The Form 2809 View Part E field is not applicable to CLER.

    The Form 2809 View Part F field denotes Cancellation = Nature of Transaction STOP.

    The Form 2809 View Part G field is not applicable to CLER.

    The data on the Form 2809 View Part H is categorized into the following fields:

    Date of Action

    Phone

  8. Select the Part I option to display the Form 2809 View (Part I) page.

    Form 2809 View Page Part I

    The data on the Form 2809 View Part I is categorized into the following fields:

    Agency Name

    Address Line 1

    Address Line 2

    Address Line 3

    City

    State

    Zip

    Foreign Country

    Agency ID

    Personnel Office ID

    Authorized Official Last Name

    Authorized Official First Name

    Authorized Official Initial

    Contact (Personnel) Last Name

    Contact (Personnel) First Name

    Contact (Personnel) Initial

    Contact (Personnel) Phone

    Contact (Payroll) Last Name

    Contact (Payroll) First Name

    Contact (Payroll) Initial

    Contact (Payroll) Phone

    Effective Date

    Date Received

    Report #

    Remarks

    Note: To view another record, select your browser’s Back button to return to the Form 2809 search results page, then select the View button next to the applicable record.

See Also

Maintaining 2809 Records

Adding a 2809 Record

Updating a 2809 Record

Releasing a 2809 Record

Canceling a 2809 Record