RI 25-7, Marital Status Certification Survey

Forms and Documents

Document Name	Status
Form RI 25-7 Marital Status Certification Survey Form and Instruction	Modified
JUSTIFICATION FOR RI 25-7.doc Justification for No Material/Nonsubstantive Change	2013-06-13
RI 25-7 March 2012 Markup.pdf Supplementary Document	2013-06-13
RI 25-7 June 2013 Markup.pdf Supplementary Document	2013-06-13
RI 25-7 SS.doc Supporting Statement A	2012-01-04

IC Document Collections

IC ID	Document Title	Status
33548	Marital Status Certification Survey Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0033	ICR Reference No: 201306-3206-001
Status: Historical Active	Previous ICR Reference No: 201201-3206-007
Agency/Subagency: OPM	Agency Tracking No:
Title: RI 25-7, Marital Status Certification Survey
Type of Information Collection: No material or nonsubstantive change to 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: 06/13/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2015	02/28/2015	02/28/2015
Responses	24,000	0	24,000
Time Burden (Hours)	6,000	0	6,000
Cost Burden (Dollars)	0	0	0

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Abstract: RI 25-7 is used to determine whether widows, widowers, and former spouses receiving survivor annuities from OPM have remarried before reaching age 55 and, thus, are no longer eligible for benefits from us. The form is revised to eliminate the option to respond to the survey via OPM's website. We request an expedited response so we can print and prepare the survey for distribution.

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Authorizing Statute(s): US Code: 5 USC 8442 Name of Law: Rights of a Widow, Widower
   US Code: 5 USC 8445 Name of Law: Rights of a Former Spouse
   US Code: 5 USC 8341 Name of Law: Survivor Annuities
  

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:
	76 FR 39927	07/07/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 82000	12/29/2011
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
Marital Status Certification Survey	RI 25-7	Marital Status Certification Survey

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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	24,000	24,000	0	0	0	0
Annual Time Burden (Hours)	6,000	6,000	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: $86,000

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? Yes

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: 06/13/2013

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