Claim for Unpaid Compensation of Deceased Civilian Employee

ICR 201503-3206-002

OMB: 3206-0234

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Unchanged
Supporting Statement A
2015-04-29
Supplementary Document
2012-01-26
Supplementary Document
2011-09-02
IC Document Collections
ICR Details
3206-0234 201503-3206-002
Historical Active 201109-3206-001
OPM
Claim for Unpaid Compensation of Deceased Civilian Employee
Reinstatement without change of a previously approved collection   No
Regular
Approved with change 04/29/2015
Retrieve Notice of Action (NOA) 03/25/2015
This collection is approved based on the revised materials provided by the Agency. OPM must report this collection as a violation in this year's ICB unless they can show it was not in use without an OMB control number.
  Inventory as of this Action Requested Previously Approved
04/30/2018 36 Months From Approved
3,000 0 0
750 0 0
0 0 0

5 CFR 178.205(a) directs the agency in which a deceased employee was last employed to request, in the order of payment precedence outlined in 5 CFR 178.204, the appropriate person or persons to execute Standard Form 1153, "Claim for Unpaid Compensation of Deceased Civilian Employee." The information collected on this form is needed by the employing agencies and, in the event of a disputed claim, by OPM to help determine the claimant's and others' rights to the unpaid compensation of the deceased employee. 31 USC 3702 authorizes the Director of the Office of Personnel Management (OPM) to settle claims involving Federal civilian employees' compensation and leave. OMB promulgated regulations at 5 CFR 178 describing general procedures applicable to claims against the United States that may be settled by the OPM Director.

US Code: 31 USC 3702 Name of Law: null
  
None

Not associated with rulemaking

  79 FR 59308 10/01/2014
80 FR 12044 03/05/2015
No

1
IC Title Form No. Form Name
Claim for Unpaid Compensation of Deceased Civilian Employee SF-1153 Claim for Unpaid Compensation of Deceased Civilian Employee

  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 3,000 0 0 0 0 3,000
Annual Time Burden (Hours) 750 0 0 0 0 750
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$30,000
No
No
No
No
No
Uncollected
Valecia Winston 202 606-2625 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/25/2015


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