Ri 25-37 Ss

OMB SUPPORTING STATEMENT

RI 25-37 – Evidence to Prove Dependency of a Child

1. Justification

1. Title 5 U. S. Code, Sections 8341(a)(3) and 8441(3) state that benefits are payable to dependent children. OPM must determine that the children are eligible. RI 25-37 is designed to inform the person applying on behalf of the child of the needed documentation to establish eligibility. RI 25-37 is mailed to the applicants along with a cover letter to explain why OPM is requesting the information.

2. Based on the evidence provided, OPM determines whether the child is eligible for survivor benefits. If the child is eligible, annuity payments are made. If this information were not collected, payments could not be authorized. The form has been revised to bring it up-to-date. The Public Burden Statement meets the requirements of 5 CFR 1320.8(b)(3). This form will be available in a PDF format on our website and meets our GPEA requirements.

3. New methods of information technology would do little to reduce the burden on the respondents. They must provide a copy of a State court order or affidavits stating specific information about the child.

4. Documentation is submitted individually. There is no duplication because the respondents initiate the collection.

5. Information is not collected from small businesses.

6. The collection of this information is performed as needed to determine entitlement and to authorize payment on individual survivor annuity claims. Less frequent collection would deny payments to children of deceased Federal employees and annuitants.

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

8. A notice of proposed information collection was published in the Federal Register on April 25, 2011, giving persons outside the agency an opportunity to comment on the form. 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.

2

12. Approximately 250 dependency determinations are made annually. It takes about one hour to assemble the needed documentation. The annual burden is 250 hours.

13. There is no cost to the respondents.

14. The annualized cost to the Federal government is $5,350. This cost includes employee salary hours devoted to the program, forms cost, and overhead.

15. There is no change in the respondent burden.

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.