Information Collection

Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits

IC 33746 under ICR 201106-3206-001 · OMB 3206-0233.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0233 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 25-51 Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits	Form and Instruction
RI 25-51 Civil Service Retirement System Survivor Annuitant Expre RI 25-051 May 2011.pdf	Form and Instruction
RI25-051 May 2011 Mark- Up.pdf RI25-051 May 2011 Markup	IC Document
RI 25-051 Dec 2010 Markup.pdf RI 25-051 Dec 2010 Markup	IC Document

IC Title:

Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RI 25-51	Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits	RI 25-051 May 2011.pdf		No		Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: OPM/Central-1

FR Citation: 73 FR 15013

Number of Respondents: 34,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	34,800	34,800
Annual IC Time Burden (Hours)	17,400	17,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
RI25-051 May 2011 Markup	RI25-051 May 2011 Mark- Up.pdf	06/02/2011
RI 25-051 Dec 2010 Markup	RI 25-051 Dec 2010 Markup.pdf	06/02/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.