SF 3102, Designation of Beneficiary (FERS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3102 SF 3102, Designation of Beneficiary (FERS)	Form and Instruction	Modified	Available
SF 3102 SS.doc	Supporting Statement A	Uploaded 2009-03-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33655	SF 3102, Designation of Beneficiary (FERS)	Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0173	ICR Reference No: 200903-3206-002
Status: Historical Active	Previous ICR Reference No: 200510-3206-003
Agency/Subagency: OPM	Agency Tracking No:
Title: SF 3102, Designation of Beneficiary (FERS)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/28/2009
	Date Received in OIRA: 03/25/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2012	36 Months From Approved	05/31/2009
Responses	3,110	0	2,893
Time Burden (Hours)	777	0	723
Cost Burden (Dollars)	0	0	0

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Abstract: This form is used by employees and annuitants covered under the Federal Employees Retirement System to designate a beneficiary to receive any lump sum due in the event of his/her death.

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Authorizing Statute(s): US Code: 5 USC 8424 Name of Law: Lump-sum Benefits; Designation of Beneficiary; Order of Precedence
  

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 10101	03/09/2009
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
SF 3102, Designation of Beneficiary (FERS)	3102	Designation of Beneficiary, Federal Employees Retirement System

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ICR Summary of Burden

table that charts list 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	3,110	2,893	0	217	0	0
Annual Time Burden (Hours)	777	723	0	54	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The number of annuitants responding per year is expected to increase as more people retire under FERS.

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Annual Cost to Federal Government: $11,444

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: 03/25/2009

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