Procedures for Submitting Compensation and Leave Claims

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OPM 1673 Procedures for Submitting Compensation and Leave Claims	Form and Instruction	Modified	Available
SSA_32060232_2008 10 31.DOC	Supporting Statement A	Uploaded 2008-10-23	Available
OPM 1673_32060232_2008 10 31.pdf	Supplementary Document	Uploaded 2008-10-23	Available
30D_73FR56868_2008 09 30_32060232.pdf	Supplementary Document	Uploaded 2008-10-23	Available
60D_73FR34352_2008 06 17_32060232.pdf	Supplementary Document	Uploaded 2008-10-23	Available
5CFR178_32060232_2008 10 31.pdf	Supplementary Document	Uploaded 2008-10-23	Available
31USC3702_32060232_2008 10 31.pdf	Supplementary Document	Uploaded 2008-10-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33743	Procedures for Submitting Compensation and Leave Claims	Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0232	ICR Reference No: 200810-3206-005
Status: Historical Inactive	Previous ICR Reference No: 200506-3206-002
Agency/Subagency: OPM	Agency Tracking No:
Title: Procedures for Submitting Compensation and Leave Claims
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 02/11/2009
	Date Received in OIRA: 10/29/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2008	36 Months From Approved	02/28/2009
Responses	40	0	40
Time Burden (Hours)	40	0	40
Cost Burden (Dollars)	0	0	0

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Abstract: 31 USC 3702 authorizes the Director of the Office of Personnel Management (OPM) to settle claims involving Federal civilian employees' compensation and leave. OMB promulgated regulations at 5 CFR 178 describing general procedures applicable to claims against the United States that may be settled by the OPM Director. 5 CFR 178.102, "Procedures for submitting claims," requires that claims for compensation, leave, and proceeds of cancelled checks for veterans' benefits payable to deceased beneficiaries be submitted by the claimant in writing and signed by the claimant or the claimant's designated (in writing) representative. The regulation describes the information that should be included in the claim and specifies that a claim may be filed with OPM only after it has been denied by the agency. No specific form is required; however, claimants may use Form OPM 1673, "Claims Coversheet," to transmit their claims to OPM. This form collects information about the claimant and provides procedures and instructions for filing such claims.

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Authorizing Statute(s): US Code: 31 USC 3702 Name of Law: null
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 34353	06/17/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 56868	09/30/2008
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Procedures for Submitting Compensation and Leave Claims	OPM 1673	Claims Coversheet

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $100,000

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

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Common Form ICR:  No

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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: 10/29/2008

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