SF 2823_Support_Stmt_August2007 No B

OMB Supporting Statement
SF 2823-

Designation of Beneficiary
(Federal Employees’ Group Life Insurance Program)

A.

Justification

1.

Title 5, United States Code, Section 8705, provides that employees and annuitants
enrolled in the Federal Employees’ Group Life Insurance (FEGLI) Program may
designate beneficiaries to receive monies payable under the FEGLI Program after
the death of the enrollee. The law also provides that if the enrollee doesn’t
designate a beneficiary, the monies will be paid according to the order of
precedence listed in section 8705(a) of the law. Title 5, Code of Federal
Regulations, section 870.802, gives further details on the requirements for a
designation of beneficiary. Section 870.909 says that an assignee can also use the
form to designate beneficiaries. (An assignee is someone who owns and controls
the insured’s insurance.)

2.

The Office of Personnel Management (OPM) uses Standard Form 2823 to collect
the information that our contractor needs in order to pay the benefits as the
enrollee or assignee wishes. Federal employees (or their assignees) file the form
with their employing agency. Annuitants (or their assignees) file the form with
OPM. OPM and agencies use the information on the form to identify where to
send claim forms upon the insured’s death. OPM’s contractor uses the
information on this form to pay life insurance benefits. We are requesting OMB
clearance of this form solely due to its use by annuitants and assignees. The
Public Burden Statement meets the requirements of 5 CFR 1320.8(b)(3).

3.

The information collected is specific to the individual and can only be obtained
from the respondents. New methods of information technology are being
developed and are closer to fruition, but their delivery is not for the foreseeable
future. However, this form is available in a PDF format on our website and meets
the GPEA requirements.

4.

Designations are filed individually. Duplication is minimized. Up-to-date, similar
information is not available.

5.

This collection of information does not impact small businesses or other small
entities.

6.

If this information were not collected, OPM’s contractor could not comply with
the provisions of the law and regulations. The contractor could not pay the life
insurance benefits as the insured or assigned desired.

7.

This information is collected at the convenience of the respondent. Less frequent
collections would deny the insured or assignee a right given in the law and
regulations.

8.

A notice of proposed information collection was published in the Federal
Register on May 8, 2007, as required by 5 CFR 1320, giving persons outside the
agency an opportunity to comment on this form. No comments were received.
Efforts to consult or engage individuals affected by collection of information on
the form can be described as informal and occasional. Communications and
consultation with affected parties are by email and telephone inquiries, as well as
constructive feedback we receive from agency personnel during our bi-annual
classroom training conferences. The inquiries take the form of questions relating
to its proper use. Feedback on the use/design of the form is generally positive.

9.

We will not pay respondents or give them gifts for responding.

10.

The information collection is protected by the Privacy Act of 1974 and OPM
regulations (5 CFR 831.106). The routine uses for disclosure appeared in the
Federal Register for OPM/Central-1 (64 FR 54930, et seq., October 8, 1999, as
amended at 65 FR 25775, May 3, 2000). The form contains a caution to
respondents that the information will be shared with the Office of Federal
Employees’ Group Life Insurance (OFEGLI) and OPM and be placed in the
insured’s personnel file.

11.

This information collection does not include questions of a sensitive nature, such
as sexual behavior and attitudes, religious beliefs, and other matters that are
commonly considered private.

12.

We process approximately 48,000 designation forms from annuitants and
approximately 1000 designation forms from assignees each year. We estimate it
takes 15 minutes to complete the form. These numbers remain consistent with the
previous statement. The annual burden is 12000 hours.

13.

The total annual cost burden to respondents or record keepers is zero.

14.

The estimated total annual cost to the Federal Government is $12,700. The cost
includes employee salary hours devoted to the program, overhead, and forms
costs.

15.

There are no changes to the respondent burden.

16.

The results of this information are not published.

17.

We again seek approval to omit displaying the expiration date for OMB approval
of the information collection. Based on experience, we know that if we display

the expiration date, personnel offices become confused and think that completed
forms on file prior to the current expiration date are invalid. As a consequence
they request new forms when the current ones are still valid. This creates
additional printings as an unintended consequence.
18.

There are no exceptions to the certification statement identified in Item 19 of the
OMB Form 83-1.