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Direct Premium Remittance System (DPRS)

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SF 2809 and SF 2810 for Corrections

This topic has been updated to replace SF 2809 and SF 2810 with the latest version. The Medicare Claim Number field has been changed to Medicare Beneficiary Identifier.

If an incorrect action was processed, the personnel office should send a corrected SF 2809 or
SF 2810 to NFC indicating the erroneous information in the Remarks block. The SF 2809 or
SF 2810 must be clearly labeled "CORRECTION."

SF 2809, FEHB Health Benefits Election Form (Part A Correction)

SF2809_Correction

OR

SF2809 FEHB Correction

See Also

Forms and Reports

SF 2809, Health Benefits Election Form

SF 2810, Notice of Change in Health Benefits Enrollment

SF 2809, Types of New Enrollments

SF 2810 and Original SF 2809 for Transfer Enrollees

DPRS 1501 and 1601 Reports

DPRS Incomplete SF 2809 Report

Submitting Transfers and Corrections