Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OPM 1523 Supplemental Semiannual Headcount Report	Form and Instruction	New	Available
Form SF 2812A Report of Withholdings and Contributions for Health Benefits by Enrollment Code	Form and Instruction	New	Available
Form SF 2812 Report of Withholdings and Contributions for Health Benefits, Life Insurance, and Retirement	Form and Instruction	New	Available
2013-20533.pdf	Supplementary Document	Uploaded 2013-11-05	Available
2013-13216.pdf	Supplementary Document	Uploaded 2013-11-05	Available
Supporting Stmt FERS-RAE FINAL to OMB.doc	Supporting Statement A	Uploaded 2013-11-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209211	OPM 1523	Form and Instruction	New	Supplemental Semiannual Headcount Report
209210	SF 2812A	Form and Instruction	New	Report of Withholdings and Contributions for Health Benefits by Enrollment Code
209209	SF 2812	Form and Instruction	New	Report of Withholdings and Contributions for Health Benefits, Life Insurance, and Retirement

ICR Details

OMB Control No: 3206-0262	ICR Reference No: 201305-3206-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: OPM	Agency Tracking No:
Title: Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/09/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/05/2013
Terms of Clearance: OPM must report this collection as a violation in this year's Information Collection Budget.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	36 Months From Approved
Responses	5,400	0	0
Time Burden (Hours)	2,700	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Public Law 112-96, Section 5001, the "Middle Class Tax Relief and Job Creation Act of 2012," makes two significant changes to the Federal Employees' Retirement System (FERS). First, beginning in 2013, new employees (as designated in the statute) will have to pay significantly higher employee contributions, an increase of 2.3 percent of salary. Second, new Members of Congress and Congressional employees, in addition to paying higher retirement contributions, will accrue retirement benefits at the same rate as regular employees. New employees affected by this law will be classified in a new retirement category; the Federal Employees' Retirement System – Revised Annuity Employees (FERS-RAE). The current Standard Form 2812, Standard Form 2812-A, and OPM Form 1523, have been changed to reflect this additional category.

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Authorizing Statute(s): PL: Pub.L. 112 - 96 5001 Name of Law: Middle Class Tax Relief and Job Creation Act of 2012
   US Code: 5 USC 83, 84, 87, 89
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 33450	06/04/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 52579	08/23/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
OPM 1523	OPM 1523	Supplemental Semiannual Headcount Report
SF 2812	SF 2812	Report of Withholdings and Contributions for Health Benefits, Life Insurance, and Retirement
SF 2812A	SF 2812A	Report of Withholdings and Contributions for Health Benefits by Enrollment Code

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	5,400	0	0	5,400	0	0
Annual Time Burden (Hours)	2,700	0	0	2,700	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in burden is due to OPM reporting the use of this previously unreported collection. Due to non-Federal entities participating in FERS, there is a potential for non-Federal employees at these organizations to have to complete these forms. The collections do not collect any PII. The vast majority of users of this collection are Federal.

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Annual Cost to Federal Government: $75,600

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/05/2013

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