RI25-051_OMBSupportingStmt no B

OMB SUPPORTING STATEMENT
RI 25-51 –

Civil Service Retirement System Survivor Annuitant Express Pay
Application for Death Benefits

A. Justification
1. Sections 8341 and 8342 of title 5, U. S. Code, provide for two types of death benefits:
survivor benefits and lump-sum payments. Survivor annuities may be payable to a
spouse, former spouse, and eligible dependent children upon the death of an employee or
annuitant. A lump-sum benefit may be payable upon the death of an employee, former
employee, or annuitant if no spouse, former spouse, or eligible dependent children are
entitled to survivor annuity or, if a survivor annuity is payable, after the right of the last
person entitled thereto has terminated. These benefits cannot be paid unless application
for the benefits is made to the Office of Personnel Management (OPM). Title 5, U. S.
Code, Section 8347(b) authorizes OPM to prescribe the form of applications needed.
2. The information collected with this application is used by the Civil Service Retirement
System solely to pay benefits to the widows or widowers of annuitants. The application
is intended for use in immediately authorizing payments to a widow or widower, based
on the report of death, when our records show that the decedent elected to provide
benefits for the applicant. The widow’s or widower’s annuity right is contingent upon
the existence of a marriage when the annuitant died and an election by the annuitant to
receive a reduced annuity during his or her lifetime to provide the survivor benefit.
Information collected on the application is carefully compared to our records to
determine that we may continue payment of benefits. The application asks specifically
for information about payment routing. The application also asks for information about
children of the deceased who may be eligible for benefits so that we may ensure that their
eligibility is considered. The Public Burden Statement meets the requirements of 5 CFR
1320.8(b)(3).
3. New methods of information technology will do little to reduce the burden because the
respondents sign the application attesting to its truth, under penalty of law.
4. Applications are filed individually. This information is not available elsewhere.
Duplication is minimized.
5. Information is not collected from small businesses.
6. This information collection is required upon the death of an annuitant. Less frequent
collection would delay the award of benefits authorized by title 5, U. S. Code, Chapter
83.
7. This information collection is consistent with the guidelines in 5 CFR 1320.6.

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8. A notice of the proposed information collection was published in the Federal Register on
May 8, 2007, giving persons outside the agency an opportunity to comment on the form.
No comments were received.
9. No payment or gift is provided to these respondents, except the annuity paid to eligible
survivors.
10. This information collection is protected by the Privacy Act of 1974 and OPM regulations
(5 CFR 831.106). The routine uses of disclosure appear 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).
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. Approximately 34,800 forms are processed annually. Completing this form requires
approximately 30 minutes including the time needed to verify the information requested.
Burden of 17,400 hours is estimated and is not expected to vary.
13. There is no cost to the respondents.
14. The annualized cost to the Federal government is $481,500. This cost includes employee
salary hours devoted to the program, forms cost, and overhead.
15. There are no changes to the respondent burden.
16. The results of this information collection are not published.
17. It is not cost effective to reprint the whole supply of forms to change the OMB clearance
expiration date. Therefore, we seek approval not to display the date on the form.
18. There are no exceptions to the certification statement.