Sf 2817 Ss

OMB Supporting Statement

SF 2817 – Life Insurance Election Form

1. Justification

1. Chapter 87 of title 5, United States code, authorizes the Office of Personnel Management (OPM) to administer the Federal Employees’ Group Life Insurance Program, and to issue regulations to carry out the provisions of the FEGLI law. The law and regulations specify that at the time an individual is hired, he or she is automatically enrolled in Basic insurance, and he/she has the opportunity to elect optional insurance. In addition, there are other circumstances and opportunities to enroll or change one’s enrollment. Standard Form 2817 – Life Insurance Election – is the form that eligible individuals use to enroll or change enrollment status under the FEGLI Program.

2. The SF 2817 is used by Federal employees and assignees (those who have acquired control of an employee/annuitant’s coverage through an assignment or “transfer” of the ownership of the life insurance). Clearance of this form for use by active Federal employees is not required according to the Paperwork Reduction Act (P.L. 98-615). The Public Burden Statement meets the requirements of 5 C.F.R. 1320.8(b)(3). Therefore, only the use of this form by assignees, i.e. members of the public, is subject to the Paperwork Reduction Act.

3. We continue to explore new and innovative methods of information technology to collect the information from employees, although that is not the audience for this request. While agencies have begun the use of information technology to process life insurance elections, it is not currently available to allow non-Federal employee assignees to utilize this same technology. As a result, we do not believe the process would be any less burdensome than it currently is. Completion of the SF 2817 is a voluntary action by the respondent, and the information collected can only be obtained from the respondent.

4. Every effort is made to identify and avoid duplication, and its occurrence is unlikely. Respondents (i.e., assignees) are never required to complete the form. The form is only completed when the assignee voluntarily chooses to reduce the insured’s life insurance coverage.

5. This information is not collected from small businesses.

6. If this information is not collected, respondents (assignees) cannot reduce the insured's’ current level of FEGLI coverage. The only way to reduce the burden would be to restrict the assignee’s ability to make changes to the enrollment. This would require a statutory and regulatory change.

7. This information collection is voluntary. Respondents aren’t required to report information-it is their choice to do so. However, in declining to provide information, the FEGLI enrollment may not be what they want. Respondents may report information more often than quarterly-it depends on their individual circumstances. There is no way to predict or control how often changes are requested.

Respondents complete the SF 2817, which includes the original and two carbon (or locally downloaded and printed) copies. The [carbon] copies are necessary to document the Official Personnel Folder (OPF) or case file, to notify the respective payroll office, and to provide the respondent a copy certified by the agency.

8. A notice of proposed information collection was published in the Federal Register on April 24, 2014, as required by 5 CFR 1320, giving persons outside the agency an opportunity to comment on this form. No comments were received.

9. No such decision has been made.

10. This information collection is protected by the Privacy Act of 1974 and OPM regulations (5 CFR 831.106 and 841.108). The routine uses of disclosure appear in the Federal Register for OPM/Central-1 (73 FR 15013 et seq,. March 20, 2008).

11. The information collected 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. We estimate that 150 SF 2817 forms will be processed each year from assignees. It is almost always in an assignee’s best interests to keep the insured’s life insurance coverage at its current level. It is rarely beneficial for an assignee to reduce or cancel such coverage-the only instance in which the assignee would use the form since new or increased coverage cannot be elected by the assignee. We estimate the SF 2817 requires approximately 15 minutes for a respondent to read the instructions and complete. Therefore, the estimated annual burden is 38 hours.

13. There are no costs to respondents or record keepers resulting from the collection of this information.

14. The annualized cost to the government for the printing and distributing this form to the assignees (estimated 150) is negligible. It is our efforts to continue to go green; we are printing a limited numbers of forms. Most individuals and agencies can download the form locally instead. Therefore, we estimate no reportable expenses incurred in the collection of this information.

15. There are no program changes or adjustments reported in Items 13 or 14 of the OMB Form 83-1.

16. The results of this information are not published.

17. We seek approval to not display the expiration date for OMB approval of the information collection. Too often, users of the form see the expiration date and erroneously assume that the form is void after that date. This form is printed and distributed throughout various agencies. It is cost prohibitive to print new forms for the sole purpose of changing the expiration date.

18. There are no exceptions.