FEGLI Implementation Questionnaire for Tribal Employers

Forms and Documents

Document Name	Status
Form FEGLI FEGLI Implementation Questionnaire for Tribal Employers Form and Instruction	New
Current FEGLI Rates_Tribes_FINAL.pdf Supplementary Document	2013-09-19
FEGLI Tribal Fact Sheet_FINAL.pdf Supplementary Document	2013-09-19
FEGLI DTLL_Signed.pdf Supplementary Document	2013-09-19
2013-22241 30 day notice.pdf Supplementary Document	2013-09-19
2013-11300 60 day notice.pdf Supplementary Document	2013-09-19
Tribal FEGLI Supporting Statement_7.2.13.doc Supporting Statement A	2013-09-19

IC Document Collections

IC ID	Document Title	Status
208748	FEGLI Implementation Questionnaire for Tribal Employers Form and Instruction	New

ICR Details

OMB Control No: 3206-0260	ICR Reference No: 201309-3206-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: OPM	Agency Tracking No:
Title: FEGLI Implementation Questionnaire for Tribal Employers
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/02/2013
	Date Received in OIRA: 09/19/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	36 Months From Approved
Responses	700	0	0
Time Burden (Hours)	58	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: In order to successfully implement access to FEGLI coverage for eligible Tribes and urban Indian organizations, an understanding of the scope of the project is needed. There is currently limited data available that could be used to provide a reasonable estimate of the anticipated number of enrollees, or the anticipated number of participating tribal entities. Additionally, there is no information available regarding the existing methods of premium collection or type of coverage used by Tribes and urban Indian organizations. Receipt of the above mentioned data, along with information related to the types of life insurance coverage currently accessed by Tribes and urban Indian organizations, and the cost thereof, will allow OPM to properly develop and effectively implement this project. In order to effectively allow OPM to determine the costs associated with the implementation, operation and enrollment in FEGLI, there is a need to gather information. The feasibility of creating and maintaining technology, and more specifically, the extent to which technology needs to be implemented, is contingent in large part on the number of anticipated enrollees. The number of interested tribal organizations and their projected enrollment will impact the cost per enrollee. The information provided by respondents as a result of this questionnaire will aid in determining the costs and procedures associated with this project. OPM's implementation strategy will be directly impacted by the number of predicted enrollees. As a result, the information gathered from this questionnaire will aid in the development of a system that is both reasonably priced and appropriately laid out to meet the needs of the anticipated enrollees.

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Authorizing Statute(s): US Code: 25 USC 1647b Name of Law: null
  

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 28007	05/13/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 56757	09/13/2013
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
FEGLI Implementation Questionnaire for Tribal Employers	FEGLI	FEGLI Implementation Questionnaire for Tribal Employers

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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	700	0	0	700	0	0
Annual Time Burden (Hours)	58	0	0	58	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 creation of this burden is due to the roll out of FEGLI to Tribal Governments based upon the passage of the Affordable Care Act.

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Annual Cost to Federal Government: $0

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]? Yes

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: 09/19/2013

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