Information Collection

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

IC 218450 under ICR 201510-3206-001 · OMB 3206-0270.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0270 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
RI 76-10 Jun 2015.pdf OMB Supporting Statement	IC Document
60-day FRN.pdf 60-Day FRN	IC Document
RI76-010_30DayFRN_Published_2015_02_19.pdf 30-Day FRN	IC Document
RI 76-10 Jun 2015.pdf Form RI 76-10 Assignment, Ferderal Employees' Group Life Insurance Program	IC Document
RI 76-10 Supporting Statement.doc OMB Justification Statement	IC Document

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 8706

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records

Title: OPM/Central-1

FR Citation: 73 FR 15013

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Supporting Statement	RI 76-10 Jun 2015.pdf	10/02/2015
60-Day FRN	60-day FRN.pdf	10/02/2015
30-Day FRN	RI76-010_30DayFRN_Published_2015_02_19.pdf	10/02/2015
Form RI 76-10 Assignment, Ferderal Employees' Group Life Insurance Program	RI 76-10 Jun 2015.pdf	10/02/2015
OMB Justification Statement	RI 76-10 Supporting Statement.doc	10/02/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.