Opm 1496a Ss

OMB SUPPORTING STATEMENT

OPM Form 1496A – Application for Deferred Retirement (Separations On or After October 1,

1956)

A. Justification

1. The Civil Service Retirement Law (5 USC 8338) and regulations (5 CFR 831.501) require that the Office of Personnel Management (OPM) adjudicate and pay deferred annuities. Deferred annuities are payable to persons who are no longer Federal employees and who have five or more years of creditable civilian service. The individual must be age 62 and must not have withdrawn his or her money from the retirement fund. OPM Form 1496A is needed to administer this provision of the law. The form provides a space for OPM to list the service of record in our files. The applicant can review the record and inform OPM of any additional Federal civilian or military service which should be included in the annuity computation.

2. The information collected is used by OPM to determine whether the applicant is eligible for a deferred annuity and to compute the amount of the annuity. The application provides the information needed to pay out monies; e.g., applicant’s signature, current mailing address, signed statement regarding marital status and name of spouse, and whether the applicant is electing a reduced annuity in order to provide a survivor annuity should a spouse or former spouse survive. The instructions attached to OPM Form 1496A have been revised to bring them up-to-date. The application now provides space for the applicant to enroll in Direct Deposit/Direct Express and to indicate how much Federal income tax should be withheld. Schedule B, Part 1 has been revised to collect the name of the former spouse should the applicant have elected a survivor benefit for that individual. Schedule C is no longer needed. The Public Burden Statement meets the requirements of 5 CFR 1320.8(b)(3).

2. The information collected is detailed and can only be obtained from the respondents. New methods of information technology would do little to reduce the burden on the respondents; they must sign the application attesting to its truth, under penalty of law, to the best of their knowledge. However, this form is available in a PDF fillable format on our website and meets our GPEA requirements.

2. Applications are filed individually. There is no duplication because the respondents initiate the collection.

2. Information is not collected from small businesses.

2. The collection of this information is performed as needed to pay eligible persons. Less frequent collection would delay the payment of annuities provided by law.

2. This collection is consistent with the guidelines of 5 CFR 1320.6.

Page 2

2. A notice of proposed information collection was published in the Federal Register on September 2, 2011, giving persons outside the agency an opportunity to comment on the forms. No comments were received.

2. OPM does not provide any payment or gift to the respondents, other than paying any benefits provided by law.

2. This information collection is protected by the Privacy Act of 1974 and OPM regulations (5 CFR 831.106 and 5 CFR 841.108). The routine uses for disclosure appear in the Federal Register for OPM/Central-1 (73 FR 15013, et seq., March 20, 2008).

2. The information collection does not include questions regarding sexual behavior and attitudes or religious beliefs, and other matters that are commonly considered private.

2. Approximately 2,800 deferred retirements are processed annually. The form requires up to one hour to complete. Burden of 2,800 hours is estimated and is not expected to vary substantially.

2. There is no cost to the respondent.

2. The annualized cost to the Federal government is $323,000. This cost includes employee salary hours devoted to the program, forms cost, and overhead.

2. There is no change in the respondent burden.

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

2. 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.

2. There are no exceptions to the certification statement.