RI 76-10 Assignment, Federal Employees' Group Life Insurance (FEGLI) Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
RI 76 10.docx	Supplementary Document	Uploaded 2016-02-25	Available
OPM central-1.doc	Supplementary Document	Uploaded 2016-02-25	Available
RI 76-10 Jun 2015.pdf	Supplementary Document	Uploaded 2015-10-09	Available
RI76-010_30DayFRN_Published_2015_02_19.pdf	Supplementary Document	Uploaded 2015-10-09	Available
60-day FRN.pdf	Supplementary Document	Uploaded 2015-10-09	Available
RI 76-10 Supporting Statement.doc	Supporting Statement A	Uploaded 2015-10-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218450	RI 76-10 Assignment, Federal Employees' Group Life Insurance (FEGLI) Program		New

ICR Details

OMB Control No: 3206-0270	ICR Reference No: 201510-3206-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: OPM	Agency Tracking No:
Title: RI 76-10 Assignment, Federal Employees' Group Life Insurance (FEGLI) Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/19/2016
	Date Received in OIRA: 10/13/2015
Terms of Clearance: This collection is approved based on the additional materials provided by the Agency.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2019	36 Months From Approved
Responses	400	0	0
Time Burden (Hours)	100	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: RI 76-10 The Federal Employees' Group Life Insurance (FEGLI) Program allows an insured individual to transfer ownership, or "assign" the FEGLI coverage, to a third party. An insured may assign for several reasons; for example, for financial planning purposes, or to comply with a court order, or to sell the coverage to a third-party. Unlike a designation of beneficiary, once an assignment is executed, it is irrevocable.

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Authorizing Statute(s): US Code: 5 USC 8706 Name of Law: Termination of Insurance; assignment owership
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 45499	08/05/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 8906	02/19/2015
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
RI 76-10 Assignment, Federal Employees' Group Life Insurance (FEGLI) Program

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ICR Summary of Burden

table that charts list 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	400	0	0	400	0	0
Annual Time Burden (Hours)	100	0	0	100	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This was an existing collection in use without an OMB control number, assignment, Federal Employees' Group Life Insurance (FEGLI), RI 76-10. The reporting population changed. The FEGLI program allows an insured individual to transfer ownership or assign the FEGLI coverage to a third party. An Insured may assign for several reason; for example, for financial planning purposes, or to comply with a court order; or to sell the coverage to a third party. Unlike a designation of beneficiary once an assignment is executed, it is irrevocable. Form has been revised to bring it up to date.

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Annual Cost to Federal Government: $0

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? No

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

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Common Form ICR:  No

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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: 10/13/2015

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