Information Collection

Death Benefit Payment Rollover Election Form

IC 33723 under ICR 200801-3206-001 · OMB 3206-0218.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0218 can be found here:

Documents and Forms

Document Name Document Type
Form RI-94-7 Death Benefit Payment Rollover Election Form Form
RI-94-7 Death Benefit Payment Rollover Election RI 94-7.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Death Benefit Payment Rollover Election Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 26 CFR 1.401(a)(31) 26 CFR 1. 402(c) 26 CFR 1.402(f) 26 CFR 3405(c) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	RI-94-7	Death Benefit Payment Rollover Election	RI 94-7.pdf		No		Paper Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title: OPM/Central-1	FR Citation: 65 FR 25775

Number of Respondents: 3,444	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,444	1,444	2,000
Annual IC Time Burden (Hours)	3,444	1,444	2,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.