RI 34-1 and 34-17, Financial Resources Questionnaire, RI 34-3 and RI 34-19, Notice of Amount Due Because of Annuity Overpayment

Forms and Documents

Document Name	Status
Form RI 34-1 Financial Resources Questionnaires, Notices of Amount Due Because of Annuity Overpayment Form and Instruction	Modified
RI 34-1 revised SS.doc Supporting Statement A	2009-06-25
60-Day FRN.pdf Supplementary Document	2009-06-02
RI 34-1 FRN.pdf Supplementary Document	2009-06-02

IC Document Collections

IC ID	Document Title	Status
33642	Financial Resources Questionnaires, Notices of Amount Due Because of Annuity Overpayment Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0167	ICR Reference No: 200901-3206-001
Status: Historical Active	Previous ICR Reference No: 200803-3206-001
Agency/Subagency: OPM	Agency Tracking No:
Title: RI 34-1 and 34-17, Financial Resources Questionnaire, RI 34-3 and RI 34-19, Notice of Amount Due Because of Annuity Overpayment
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/29/2009
	Date Received in OIRA: 06/29/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2012	36 Months From Approved	07/31/2009
Responses	2,081	0	2,081
Time Burden (Hours)	2,081	0	2,081
Cost Burden (Dollars)	0	0	0

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Abstract: Financial Resources Questionnaire, forms RI 34-1 and RI 34-17, collects detailed financial information for use by OPM to determine whether to agree to a waiver, compromise, or adjustment of the collection of erroneous payments from the Civil Service Retirement and Disability Fund. Notice of Amount Due Because Of Annuity Overpayment, forms RI 34-3 and RI 34-19, informs the annuitant about the overpayment and collects information from the annuitant about how repayment will be made. RI 34-17 and RI 34-19 are new forms created at the request of the Office of the General Counsel and the Insurance Policy Group to clearly differentiate between annuity overpayments and insurance premium underpayments.

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Authorizing Statute(s): US Code: 31 USC Section 3716 Name of Law: Administrative Offset
  

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 58685	10/07/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 23224	05/18/2009
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Financial Resources Questionnaires, Notices of Amount Due Because of Annuity Overpayment	RI 34-1, RI 34-3, RI 34-19, RI 34-17	Financial Resources Questionnaire ,   Notice of Amount Due Because of Annuity Overpayment ,   Financial Resources Questionnaire, FEGLI Premiums Underpaid ,   Notice of Amount Due Because of FEGLI Premium Underpayment

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,081	2,081	0	0	0	0
Annual Time Burden (Hours)	2,081	2,081	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: $114,200

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? Yes

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)? No

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: 06/29/2009

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