RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit

Forms and Documents

Document Name	Status
Form RI 20-123 RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit Form	New
Background_RI20-123.doc Supplementary Document	2010-10-14
60-day FRN.pdf Supplementary Document	2010-10-14
RI 20-123 30-day FRN.pdf Supplementary Document	2010-10-14
RI 20-123 SS.doc Supporting Statement A	2010-10-14

IC Document Collections

IC ID	Document Title	Status
194854	RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit Form	New

ICR Details

OMB Control No: 3206-0254	ICR Reference No: 201010-3206-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: OPM	Agency Tracking No:
Title: RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/17/2011
	Date Received in OIRA: 11/02/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2014	36 Months From Approved
Responses	720	0	0
Time Burden (Hours)	60	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Form RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit is available only on the OPM website. It is used by retirees separated for disability and the survivors of retirees separated for disability to request that Retirement Operations review the computations of disability annuities to include the formulae provided in law for individuals who performed service as law enforcement officers, firefighters, nuclear materials carriers, air traffic controllers, Congressional employees, and Capitol and Supreme Court police.

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Authorizing Statute(s): US Code: 5 USC 8337 Name of Law: Disability Retirement (CSRS)
   US Code: 5 USC 8339 Name of Law: Computation of Annuity (CSRS)
   US Code: 5 USC 8452 Name of Law: Computation of disability annuity (FERS)
  

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:
	75 FR 30867	06/02/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 61784	10/06/2010
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
RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit	RI 20-123	Request for Case Review for Enhanced Disability Annuity Benefit

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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	720	0	0	720	0	0
Annual Time Burden (Hours)	60	0	0	60	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: This is a new collection. The annual usage is expected to decrease in the future because the pool of persons affected is finite and they will only use this form once.

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Annual Cost to Federal Government: $5,550

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 11/02/2010

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