SF 3102, Designation of Beneficiary (FERS)

Forms and Documents

Document	Type	Status	Availability
Form SF 3102 SF 3102, Designation of Beneficiary (FERS)	Form and Instruction	Unchanged	Repair queued
FRN 30 DAY 2015-01340.pdf	Supplementary Document	Uploaded 2015-01-26	Repair queued
60-Day FRN.pdf	Supplementary Document	Uploaded 2015-01-26	Available
SF 3102 SS.doc	Supporting Statement A	Uploaded 2011-12-12	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
33655	SF 3102, Designation of Beneficiary (FERS)	Form and Instruction	Unchanged

ICR Details

OMB Control No: 3206-0173	ICR Reference No: 201501-3206-003
Status: Historical Active	Previous ICR Reference No: 201112-3206-001
Agency/Subagency: OPM	Agency Tracking No:
Title: SF 3102, Designation of Beneficiary (FERS)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/03/2015
	Date Received in OIRA: 01/26/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2018	36 Months From Approved	02/28/2015
Responses	3,888	0	3,888
Time Burden (Hours)	972	0	972
Cost Burden (Dollars)	0	0	0

---

Abstract: This form is used by employees and annuitants covered under the Federal Employees Retirement System to designate a beneficiary to receive any lump sum due in the event of his/her death. The form was revised to add "Domestic Partner" to the Examples of Designations.

---

Authorizing Statute(s): US Code: 5 USC 8424 Name of Law: Lump-sum Benefits; Designation of Beneficiary; Order of Precedence
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 104	05/30/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 16	01/26/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
SF 3102, Designation of Beneficiary (FERS)	SF 3102	Designation of Beneficiary (FERS)

---

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	3,888	3,888	0	0	0	0
Annual Time Burden (Hours)	972	972	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:

---

Annual Cost to Federal Government: $15,124

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

---

Common Form ICR:  No

---

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: 01/26/2015

---