Ri 20-123 Ss

OMB SUPPORTING STATEMENT

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

1. Justification

1. Title 5, U. S. Code, Chapter 83, Sections 8337 and 8339, and Chapter 84, Section 8452, provide for disability retirement benefits for individuals who performed service as law enforcement officers, firefighters, nuclear materials carriers, Customs and Border Patrol officers, members of the Capitol and the Supreme Court police, Congressional employees, and air traffic controllers. Recent court decisions affect the computations of these benefits. Because these court orders were handed down long after some of the affected individuals retired and/or died and the individuals are not identified in the Office of Personnel Management (OPM) computer systems, it is necessary for the affected individuals to self-identify. Form RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit is used by the affected individuals and their survivors to request that their benefits computations be reviewed.

2. RI 20-123 is available to annuitants and survivor annuitants only on the OPM website. When responses are received, action is taken to review the annuity computation and, if the respondent is entitled to an increased benefit, the benefit is authorized. The Public Burden Statement meets the requirement of 5 CFR 1320.8(b)(3).

3. Improved information technology is being used. This form is available in a PDF fillable format on our website and meets our GPEA requirements.

4. The forms are filed individually. Similar information is not available.

5. Information is not collected from small businesses.

6. The collection of this information is performed as needed to determine the correct amount to pay annuitants and survivor annuitants.

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

8. A 60-day notice of the proposed information collection was published in the Federal Register on June 2, 2010, as required by 5 CFR 1320, giving persons outside the agency an opportunity to comment on the form. No comments were received.

9. No payment or gift is made to the respondents.

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10. This information collection is protected by the Privacy Act of 1974 and OPM regulations (5 CFR 831.106). The routine uses of disclosure appear in the Federal Register for OPM/Central-1 (73 FR 15013, et seq., March 20, 2008, effective April 21, 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 720 forms will be processed annually. The form requires approximately 5 minutes to complete. Burden of 60 hours is estimated. 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.

13. There is no cost to the respondents.

14. The annualized cost to the Federal government is $5,550. This cost includes employee salary hours devoted to the program, forms and overhead.

15. This is a new respondent burden.

16. The results of this collection are not published.

17. The expiration date of the OMB clearance will be displayed on the form.

18. There are no exceptions to the certification statement.