In order to
comply with the Paperwork Reduction Act, this form should be
changed so that OPM complies with the requirement that it provides
respondents with all information specified in 5 CFR 1320.8(b)(3).
In addition--OPM may make the following change to the form: Reverse
the position of the boxes dealing with "elected Living Benefits"
and "I am the Insured/an Assignee" and add before "please check:"
in the Living Benefits box the phrase "If the insured," so that it
will read as follows: "If the insured, please check:". This change
may be helpful to respondents since an assignee cannot elect living
benefits.
Inventory as of this Action
Requested
Previously Approved
07/31/1999
07/31/1999
1,000
0
0
250
0
0
0
0
0
This form is used by any Federal
employee or retiree covered by the Federal Employees' Group Life
Insurance to designate how to distribute the proceeds of his/her
life insurance when the statutory order of precedence does not meet
his/her needs.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.