3206-0156_ss

SF 2800 SF 2800A

SF 2800-1

OOMB SUPPORTING STATEMENT

Application for Death Benefits (CSRS)

Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee at the Time of Death

Applying for Death Benefits under the Civil Service Retirement System

A. Justification

1. Title 5, U. S. Code, Chapter 83, Sections 8341 and 8342 provide for two types of death benefits: survivor benefits and lump-sum payments. Survivor annuities may be payable to a spouse, former spouse, and eligible dependent children upon the death of an employee or annuitant. A lump-sum benefit may be payable upon the death of an employee, former employee, or annuitant if no spouse, former spouse, or eligible dependent children are entitled to survivor annuity or, if a survivor annuity is payable, after the right of the last person entitled thereto has terminated. These benefits cannot be paid unless application for the benefits is made to the Office of Personnel Management (OPM). Title 5, U. S. Code, Section 8347(b) authorizes OPM to prescribe the form of applications needed.

2. The information collected by these applications is used by the Civil Service Retirement System to authorize payment of benefits in the event of the death of an employee, a former employee, or an annuitant. SF 2800 collects information from the survivors of deceased employees and deceased annuitants. SF 2800A collects information needed from survivors of employees who die in service. This information is already available if the deceased is an annuitant. 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. The Public Burden Statement meets the requirements of 5 CFR 1320.8(b)(3).

3. New methods of information collection technology will do little to reduce the burden as the information collected is detailed and can only be obtained from the respondents who sign the application attesting to its truth, under penalty of law, to the best of their knowledge. However, these forms are available in a PDF fill-able format on our website and meet the GPEA requirements.

4. Applications are filed individually. This information is not available elsewhere.

Duplication is minimized.

5. Information is not collected from small businesses.

6. Information collection is required upon the death of an employee, a former employee, or an annuitant. Less frequent collections would delay the award of benefits authorized by title 5, U. S. Code, Chapter 83.

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7. The information collection is consistent with the guidelines in 5 CFR 1320.6.

8. A notice of pro posed information collection was published in the Federal Register on December 8, 2008, as required by 5 CFR 1320, giving persons outside the agency an opportunity to comment on the forms. No comments were received.

9. No payment or gift is provided to these respondents.

10. This information collection is protected by the Privacy Act of 1974 and OPM regulations
    (5 CFR 831.106). The routine uses for disclosure appear in the Federal Register for OPM/Central-1 (73 FR 15013, et seq., March 20, 2008).

11. This information collection does not include questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private.

12. Approximately 68,000 SF 2800s are processed annually. SF 2800 requires approximately 45 minutes to complete, including the time required to verify the information requested. A burden of 51,000 hours is estimated. Approximately 6,800 applicants will use SF 2800A annually. This form also requires approximately 45 minutes to complete for a burden of 5,100 hours. The total burden for these forms is 56,100 hours.

13. There is no cost to the respondents.

14. The annualized cost to the Federal government is $1,201,200. This cost was determined by employee salary hours devoted to the program, forms cost, and overhead.

15. There no changes to the respondent burden. The number 56,100 was erroneously entered as the respondent number instead of the burden time. Once this error was discovered, the correct respondent number of 74,800 was entered, causing the collection to register a “change” in burden which never existed.

16. The results of this information collection are not published.

17. It is not cost effective to reprint the whole supply of forms to change the OMB clearance expiration date. Therefore, we seek approval not to display the date on the form.

18. There are no exceptions to the certification statement.