Ri 20-123 Ss

OMB SUPPORTING STATEMENT

RI 20-123 – Request for Case Review for Enhanced Disability Annuity Benefit

1. Justification

1. Title 5, U. S. Code, Chapter 83, Sections 8337 and 8339, and Chapter 84, Section 8452, provide for disability retirement benefits for individuals who performed service as law enforcement officers, firefighters, nuclear materials carriers, Customs and Border Patrol officers, members of the Capitol and the Supreme Court police, Congressional employees, and air traffic controllers. A series of court decisions affect the computation of benefits. Because these court orders were handed down long after some of the affected individuals retired and/or died and the individuals are not identified in the Office of Personnel Management (OPM) computer systems, it is necessary for the affected individuals to self-identify. Form RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit, is used by the affected individuals and their survivors to request that their benefit computations be reviewed.

2. RI 20-123 is available to annuitants and survivor annuitants only on the OPM website. When responses are received, action is taken to review the annuity computation and, if the respondent is entitled to an increased benefit, the benefit is authorized. The Public Burden Statement meets the requirement of 5 CFR 1320.8(b)(3).

3. Improved information technology is being used. This form is available in a PDF fillable format on our website and meets our GPEA requirements.

4. The forms are filed individually. Similar information is not available.

5. Information is not collected from small businesses.

6. The collection of this information is performed as needed to determine the correct amount to pay annuitants and survivor annuitants.

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

8. A 60-day notice of the proposed information collection was published in the Federal Register on August 23, 2013, 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 made to the respondents.

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10. This information collection is protected by the Privacy Act of 1974 and OPM regulations (5 CFR 831.106). The routine uses of disclosure appear in the Federal Register for OPM/Central-1 (73 FR 15013, et seq., March 20, 2008, effective April 21, 2008).

11. This information collection does not include questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private.

12. It is estimated that approximately 100 forms are expected to be processed annually. The form may require approximately 5 minutes for completion and an annual burden of 25 hours is estimated.

13. There is no cost to the respondent.

14. The annualized cost to the Federal government is $5,550. This cost includes employee salary hours devoted to the program, forms and overhead.

15. The annual burden has decreased because we have not received the anticipated number of responses. Since the initial inception of this form, it appears that the majority of individuals affected has contacted OPM and have received a response.

16. The results of this 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.