OPM1530OMBSuppStmt

OMB SUPPORTING STATEMENT

OPM Form 1530­ - Report of Medical Examination of Person Electing Survivor Benefits under the Civil Service Retirement System

A. Justification

1. Title 5, U. S. Code, Section 8339(k)(I) provides that at retirement any person in good health may elect a reduced annuity in order to provide a survivor benefit for a person who has an insurable interest in the applicant for retirement. Insurable interest exists if the survivor is a person who would suffer financially because of the death of the applicant.

2. When an insurable interest survivor election is indicated, a medical examination is required so that the Office of Personnel Management (OPM), Civil Service Retirement System, can determine whether the applicant is in good health, that is, free from any condition that would cause death or shorten life expectancy. OPM Form 1530 is designed to collect information from both the applicant and the applicant's physician regarding the applicant's health. This information is used to determine whether the insurable interest survivor benefits election can be allowed. The form has been revised to bring it up-to-date. The Public Burden Statement meets the requirements of 5 CFR 1320.8(b)(3).

3. The information collected is detailed and can only be obtained from the respondents. New methods of information technology would do little to reduce the burden on the respondents. However, this form is available in a pdf fillable format on our website and meets our GPEA requirements.

4. Applications are filed individually. There is no duplication because the respondents initiate the collection.

5. Information is not collected from small businesses.

6. The collection of this information is performed as needed to grant the survivor reduction to eligible persons. Less frequent collection would deny this benefit which is provided by law.

7. This collection is consistent with the guidelines of 5 CFR 1320.6.

8. A notice of proposed information collection was published in the Federal Register on, July 17, 2007, giving persons outside the agency an opportunity to comment on the forms. No comments were received.

9. No payment or gift is provided to these respondents.

10. This information collection is protected by the Privacy Act of 1974 and OPM regulations (5 CFR 831.106 and 5 CFR 841.108). The routine uses for disclosure appear in the Federal Register for OPM/Central-l (64 FR 54930, et seq., October 8, 1999, as amended at 65 FR 25775, May 3, 2000).

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11. The information collection does not include questions regarding sexual behavior and attitudes or religious beliefs, and other matters that are commonly considered private. However, the collection does include questions about the health and physical condition of the applicant because these matters are fundamental to the decision as to whether to allow the insurable interest survivor election.

12. Approximately 500 annuitants apply to elect an insurable interest survivor annuity each year. The form requires approximately one hour and 30 minutes to complete. This includes the time needed to undergo a physical examination and enter the results on the form. A burden of 750 hours is estimated and is not expected to vary substantially.

13. A physician's report is required to document the state of the applicant's health. There is no way to estimate the cost to the respondent because the respondent mayor may not have had a recent physical examination on which to base the physician's report.

14. The annualized cost to the Federal government is $22,100. This cost includes

employee salary hours devoted to the program, forms cost, and overhead.

15. There is no change 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.