RI20-126_OMBSupportingStatement_2015

OMB SUPPORTING STATEMENT

RI 20-126 – Certification of Qualifying District of Columbia Service Under Section 1905 of

Public Law 111-84

1. Justification

1. Section 1905 of Public Law 111-84 pertains to Retirement Credit for Service of Certain Employees Transferred from District of Columbia Service to Federal Service. In general, any individual who is treated as an employee of the Federal Government for purposes of chapter 83 or chapter 84 of title 5, U. S. Code, on or after October 28, 2009, or who performed qualifying District of Columbia service shall be entitled to have such service included in calculating creditable service under section 8332 or 8411 of title 5, United States Code, but only for purposes of meeting retirement eligibility. Form RI 20-126, Certification of Qualifying District of Columbia Service under Section 1905 of Public Law 111-84 is used by affected individuals and their survivors to request that their service is reviewed for meeting retirement eligibility.

2. RI 20-126 is available to employees covered under the Civil Service Retirement System (CSRS) or the Federal Employees Retirement System on or after October 28, 2009. Those eligible to apply include an applicant employed with the District of Columbia Courts; or an employee who performed service in an entity of the DC government whose functions were transferred to the Pretrial Services, Parole, Adult Supervision, and Offender Supervision Trustee; an employee of the Public Defender Service for the District of Columbia; and an employee of the DC Department of Corrections who was separated from service as a result of the closing of the Lorton Correctional Complex When responses are received, an agency official must certify that certain service performed qualifies to meet retirement eligibility. However, the service cannot be used in the computation of annuity. The Public Burden Statement meets the requirement of 5 CFR 1320.8(b)(3).

3. Improved information technology is being used. This form is available in a PDF fillable format on our website and meets our GPEA requirements.

4. The forms are filed individually. Similar information is not available.

5. Information is not collected from small businesses.

6. The collection of this information is performed as needed to determine the correct amount to pay annuitants and survivor annuitants.

7. This information collection is consistent with the guidelines in 5 CFR 1320.6.

8. A 60-day notice of the proposed information collection was published in the Federal Register on May 4, 2015, as required by 5 CFR 1320, giving persons outside the agency an opportunity to comment on the form. No comments were received.

9. No payment or gift is made to the respondents.

10. This information collection is protected by the Privacy Act of 1974 and OPM regulations (5 CFR 831.106). The routine uses of disclosure appear in the Federal Register for OPM/Central-1 (73 FR 15013, et seq., March 20, 2008, effective April 21, 2008).

11. This information collection 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. It is estimated that approximately 1,000 forms are expected to be processed annually. The form may require approximately 30 minutes for completion and an annual burden of 500 hours is estimated. The annual usage is expected to decrease in the future because the pool of persons affected is finite and they will only use this form once.

13. There is no cost to the respondents.

14. The annualized cost to the Federal government is $5,550. This cost includes employee salary hours devoted to the program, forms and overhead.

15. There is no cost to the respondent.

16. The results of this collection are not published.

17. The expiration date of the OMB clearance will be displayed on the form.

18. There are no exceptions to the certification statement.