RI 20-7 - Representative Payee Application, RI 30-3 - Information Necessary for a Competency Determination

Forms and Documents

Document Name	Status
Form RI 20-7 RI 20-7, Representative Payee Application/RI 30-3, Information Necessary for a Competency Determination Form and Instruction	Modified
RI30-3 June 2010 markup.pdf Supplementary Document	2013-05-14
RI 30-3 Aug 2013 markup.pdf Supplementary Document	2013-05-14
RI 20-7 June 2010 markup.pdf Supplementary Document	2013-05-14
RI 20-7 August 2013 markup.pdf Supplementary Document	2013-05-14
30-day FRN.pdf Supplementary Document	2013-05-14
60-day FRN.pdf Supplementary Document	2013-05-14
RI 20-7 SS.doc Supporting Statement A	2013-05-14

IC Document Collections

IC ID	Document Title	Status
33606	RI 20-7, Representative Payee Application/RI 30-3, Information Necessary for a Competency Determination Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0140	ICR Reference No: 201305-3206-004
Status: Historical Active	Previous ICR Reference No: 201004-3206-009
Agency/Subagency: OPM	Agency Tracking No:
Title: RI 20-7 - Representative Payee Application, RI 30-3 - Information Necessary for a Competency Determination
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/14/2013
	Date Received in OIRA: 05/15/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2016	36 Months From Approved	07/31/2013
Responses	12,480	0	12,480
Time Burden (Hours)	6,490	0	6,490
Cost Burden (Dollars)	0	0	0

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Abstract: RI 20-7, Representative Payee Application, is used by the Civil Service Retirement System (CSRS) and the Federal Employees Retirement System (FERS) to collect information from persons applying to be fiduciaries for annuitants or survivor annuitants who appear to be incapable of handling their own funds or for minor children. RI 30-3, Information Necessary for a Competency Determination, collects medical information regarding the annuitant's competency for OPM's use in evaluating the annuitant's condition. Both forms have been revised to bring the Public Burden Statement up-to-date.

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Authorizing Statute(s): US Code: 5 USC Chapter 83 Section 8345 Name of Law: CSRS, Payment of Benefits; commencement, termination, and waiver of annuity
   US Code: 5 USC Chapter 83 Section 8344 Name of Law: CSRS, Annuities & Pay on Reemployment
   US Code: 5 USC Chapter 84 Section 8466 Name of Law: FERS, Application for Benefits
  

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:
	77 FR 71200	11/20/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 28007	05/13/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
RI 20-7, Representative Payee Application/RI 30-3, Information Necessary for a Competency Determination	RI 20-7, RI 30-3	Representative Payee Application ,   Information Necessary for a Competency Determination

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ICR Summary 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	12,480	12,480	0	0	0	0
Annual Time Burden (Hours)	6,490	6,490	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $198,850

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: 05/15/2013

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