OMB Justification Statement

OMB Supporting Statement

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

OMB Control Number: 3206-XXXX

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.

2. The RI 76-10 is used by Federal employees, annuitants, compensationers, and assignees. 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 capable of allowing the completion of this form RI 76-10. Section D of this form requires witnesses to the signature which cannot be done in an electronic manner. As a result, we do not believe the process would be any less burdensome than it currently is. Completion of the RI 76-10 is a voluntary action by insured Federal employee, annuitant, compensationer or assignee, and the information collected can only be obtained from the insured Federal employee, annuitant, compensationer or assignee.

4. Every effort is made to identify and avoid duplication, and its occurrence is unlikely. This form is used specifically to give ownership and control of one’s Basic, Option A, and/or Option B life insurance coverage to someone else. Respondents (i.e., assignees) are not required to complete the form unless they decide to assign their share of the insurance to another person(s), firm(s) or trust(s).

5. This information is not collected from small businesses.

6. If this information is not collected, the employees, annuitants and compensationers cannot assign their coverage to someone else. In addition, the completed form will show that respondents (assignees) are now the owners of the FEGLI and can take other actions as allowed by regulations.

7. This information collection is voluntary. Respondents aren’t required to report information-it is their choice to do so if they choose to assign the life insurance to someone else. However, in declining to provide information, the FEGLI cannot be assigned to a new owner.

Respondents complete the RI 76-10, 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, and to provide both the insured and the respondent (i.e., assignee) a copy certified by the agency.

8. A notice of proposed information collection was published in the Federal Register on August 5, 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 400 RI 76-10 forms will be processed each year. We estimate the RI 76-10 requires approximately 15 minutes for a respondent to read the instructions and complete. Therefore, the estimated annual burden is 100 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 400) 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.