RI 30-1 Supporting Statement

OMB SUPPORTING STATEMENT

RI 30-1 – Request to Disability Annuitant for Information on Physical Condition

and Employment

A. Justification

1. Title 5, U. S. Code, Chapter 83, Section 8337(c) and Chapter 84, Section 8454 provide that a disability annuitant under age 60 shall be examined at the end of one year from the date of the disability retirement and reexamined annually thereafter under the direction of the Office of Personnel Management (OPM), unless OPM determines that the disability is permanent. If the annuitant fails to submit to examination, payment of the annuity shall be suspended until continuing eligibility for disability annuity is established.

Title 5, U. S. Code, Chapter 83, section 8337(d) and Chapter 84, section 8455 provide that a disability annuitant under age 60 is no longer eligible for disability annuity if he or she earns 80 percent of the current rate of pay of the position occupied immediately before retirement. The information collected on the reverse of RI 30-1 is used to verify whether the respondent is earning 80 percent of the current rate of pay. Further, title 5, U. S. Code, Chapter 83, section 8337(f) and Chapter 84, section 8464a provide that an individual is not entitled to receive an annuity from OPM and compensation for an on-the-job injury under subchapter I of chapter 81, other than compensation payable under section 8107, covering the same period of time. Information is collected on the reverse of RI 30-1 to enable OPM to determine whether the respondent is receiving payments from the Department of Labor which would affect eligibility for annuity.

2. At the end of the first year of an approved disability retirement and annually thereafter, form RI 30-1 is forwarded to annuitants to whom these provisions are applicable. OPM determines whether the conditions to continue the annuity are met. If this information is not collected, we might continue to pay benefits to persons who are no longer entitled. The form was revised to bring it up to date. Public Burden Statement meets the requirements of 5 CFR 1320.8(b)(3).

3. The information collected 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 questionnaire attesting to its truth, under penalty of law, to the best of their knowledge. However, this form is available on our website in a pdf fillable format and meets our GPEA requirement.

4. Responses are filed individually. Only one response is needed from each individual.

5. Information is not collected from small businesses.

6. The collection of this information is performed as needed to pay eligible persons. Less frequent collection would cause OPM to pay to persons who may no longer be eligible.

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

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8. A notice of proposed information collection was published in the Federal Register on November 2, 2012, 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 provided to 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 (75 FR 15013, et seq., March 20, 2008).

11. This information collection includes questions concerning the respondent’s medical condition and income; this information is commonly considered private and is protected by OPM as described in item 10 above. The medical information must be collected in order for OPM to compare it with the prior medical information submitted and to determine whether the respondent is still disabled and eligible for continuing annuity payments. The information regarding income and whether there is an award of benefits from the Department of Labor is also used to determine that the annuity benefit is still payable. The respondent is not required to answer these questions; however, since OPM cannot legally continue payments if there is no response, RI 30-1 clearly states that OPM will suspend payments if a reply is not received.

12. The number of respondents is approximately 8,000. The form requires about one hour to complete including the doctor’s time. The annual burden is 8,000 hours. See item 13 for the cost to the respondents.

13. Each respondent must provide medical documentation with the response. Since the cost would vary, we estimate an average cost of $150 for this documentation, resulting in an annualized average cost of $1,200,000 to respondents (based on 8,000 responses per year).

14. The annualized cost to the Federal government is $93,900. This cost was determined by 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.