Supporting Statement for OPM1825

Supporting Statement for OPM 1825

1. The Civilian Service Recognition Act of 2011 (Public Law 112-73) authorizes an agency to furnish a United States flag on behalf of an employee who dies of injuries incurred in connection with his/her employment under specified circumstances. OPM Form OPM 1825, Application for U.S. Flag Recognition Benefit for Deceased Federal Civilian Employees, may be used to determine deceased Federal employee and beneficiary (e.g., family member of a deceased employee) eligibility for issuance of a U.S. flag. The form may be used by any Federal entity and use of the form is at agency discretion. .

2. The employee and beneficiary information is collected on OPM 1825, and submitted to the agency to determine eligibility for issuance of the U.S. Flag. The agency retains the forms in their files.

Agencies equipped to accept electronic signatures may use an electronic version of the form.

3. Agencies equipped to accept electronic signatures may use an electronic version of the form. The form will be available for public printing. The results of the information collection will not be made available to the public over the Internet. OPM anticipates rate use of this optional form.

4. Various beneficiary forms may duplicate employee and beneficiary information requested on OPM 1825.

5. Not applicable. OPM 1825 does not impact small businesses or other small entities.

6. Not applicable. The form is optional, and agencies may request the information without this form.

7. Not applicable.

8. The 60-day Federal Register Notice was published June 17, 2013 (Volume 78, Number 116, pages 36314). We received no comments as a result of the 60-day Federal Register Notice, published in the Federal Register on June 17, 2013.

9. Not applicable. OPM does not provide any payments or gifts to individuals.

10. OPM 1825 includes a Privacy Act Information statement. The statement indicates that they forms are in full compliance with 5 U.S.C. 552a(b) (the Privacy Act of 1974) and other laws protecting the rights of the respondent.

11. Not applicable.

12. Ten total respondents are expected to complete OPM 1825 each year with an average of ten minutes required for each response. The estimated annual burden is approximately 2 hours.

13. Not applicable.

14. Not applicable. No costs beyond the normal labor costs for staff are expected.

15. Not applicable.

16. Not applicable.

17. We are requesting that the expiration date not be displayed because it is not cost effective to revise and distribute new copies given that the changes expected to be made to these forms are ministerial and administrative in nature.

18. Not applicable.