Application for Death Benefits Under the Civil Service Retirement System Documentation and Elections in Support of Application for Death Benefits When Deceased Was an...

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SF-2800A Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee at the Time of Death	Form and Instruction	Modified	Available
Form SF-2800 Application for Death Benefits under the Civil Service Retirement System (CSRS)	Form and Instruction	Modified	Available
60-day FRN.pdf	Supplementary Document	Uploaded 2009-04-21	Available
FRN.pdf	Supplementary Document	Uploaded 2009-04-21	Available
SF2800-1 (12-08).pdf	Supplementary Document	Uploaded 2009-04-21	Available
SF2800A_June2006MarkUp.pdf	Supplementary Document	Uploaded 2009-04-20	Available
SF2800A_December2008MarkUp.pdf	Supplementary Document	Uploaded 2009-04-20	Available
SF2800_June2006MarkUp.pdf	Supplementary Document	Uploaded 2009-04-20	Available
SF2800_December2008MarkUp.pdf	Supplementary Document	Uploaded 2009-04-20	Available
3206-0156_SS.doc	Supporting Statement A	Uploaded 2009-06-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33627	Application for Death Benefits Under the Civil Service Retirement System Documentation and Elections in Support of Application for Death Benefits When Deceased Was an...	Form and Instruction	Modified	Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee at the Time of Death
33627	Application for Death Benefits Under the Civil Service Retirement System Documentation and Elections in Support of Application for Death Benefits When Deceased Was an...	Form and Instruction	Modified	Application for Death Benefits under the Civil Service Retirement System (CSRS)

ICR Details

OMB Control No: 3206-0156	ICR Reference No: 200904-3206-006
Status: Historical Active	Previous ICR Reference No: 200508-3206-002
Agency/Subagency: OPM	Agency Tracking No:
Title: Application for Death Benefits Under the Civil Service Retirement System Documentation and Elections in Support of Application for Death Benefits When Deceased Was an...
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: 06/25/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/30/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2012	36 Months From Approved	06/30/2009
Responses	74,800	0	56,100
Time Burden (Hours)	56,100	0	56,100
Cost Burden (Dollars)	0	0	0

---

Abstract: SF 2800 is needed to collect information so that OPM can pay death benefits to the survivors of Federal employees and annuitants. SF 2800A is needed for deaths in service so that survivors can make the needed election regarding military service. Every applicant who uses SF 2800 should read SF 2800-1, Applying for Death Benefits under CSRS. This brief booklet provides the general information applicants need to understand what they are applying for.

---

Authorizing Statute(s): US Code: 5 USC Chapter 83, Section 8341 Name of Law: Survivor Annuities
   US Code: 5 USC Chapter 83, Section 8342 Name of Law: Lump-sum benefits; designation of beneficiary; order
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 74536	12/08/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 14171	03/30/2009
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Application for Death Benefits Under the Civil Service Retirement System Documentation and Elections in Support of Application for Death Benefits When Deceased Was an...	SF-2800, SF-2800A	Application for Death Benefits under the Civil Service Retirement System (CSRS) ,   Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee at the Time of Death

---

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	74,800	56,100	0	18,700	0	0
Annual Time Burden (Hours)	56,100	56,100	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:

---

Annual Cost to Federal Government: $1,201,200

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

---

Common Form ICR:  No

---

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: 04/30/2009

---