Annuity Supplement Earnings Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form RI-92-22 Annuity Supplement Earnings Report	Form	Modified	Available
RI92-022 (01-07) Markup.pdf	Supplementary Document	Uploaded 2007-05-08	Available
RI 92-22 (02-06) markup.pdf	Supplementary Document	Uploaded 2007-05-08	Available
RI 92-22 SS.doc	Supporting Statement A	Uploaded 2007-05-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33678	Annuity Supplement Earnings Report	Form	Modified

ICR Details

OMB Control No: 3206-0194	ICR Reference No: 200705-3206-003
Status: Historical Active	Previous ICR Reference No: 200309-3206-003
Agency/Subagency: OPM	Agency Tracking No:
Title: Annuity Supplement Earnings Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/17/2007
	Date Received in OIRA: 05/24/2007
Terms of Clearance: This information collection request is approved. Please note that OMB modified the burden table to indicate that the change in burden is an agency adjustment, not a program change, consistent with the OPM-provided supporting statement.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2010	36 Months From Approved	08/31/2007
Responses	13,000	0	700
Time Burden (Hours)	3,250	0	175
Cost Burden (Dollars)	0	0	0

---

Abstract: The Annuity Supplement Earnings Report, RI 92-22, is used annually to obtain the amount of personal earnings from annuity supplement recipients to determine if there should be a reduction in benefits paid to the annuitant.

---

Authorizing Statute(s): US Code: 5 USC Chapter 84, Section 8421 Name of Law: FERS, Annuity Supplement
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 67934	11/24/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 26185	05/08/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Annuity Supplement Earnings Report	RI-92-22	Annuity Supplement Earnings Report

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	13,000	700	0	0	12,300	0
Annual Time Burden (Hours)	3,250	175	0	0	3,075	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The burden has increased due to the increase in the number of persons retiring under FERS.

---

Annual Cost to Federal Government: $40,500

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 05/24/2007

---