Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits

Forms and Documents

Document Name	Status
Form RI 25-51 Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits Form and Instruction	Unchanged
RI25-051_30dayFRNPublished_2017_05_05.pdf Supplementary Document	2017-05-12
RI25-051_OMB_Support_Stmt_2017_04_11.doc Supporting Statement A	2017-05-12
RI25-051_60DayFRN_Published_2016_07_21.pdf Supplementary Document	2017-01-10

IC Document Collections

IC ID	Document Title	Status
33746	Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits Form and Instruction	Unchanged

ICR Details

OMB Control No: 3206-0233	ICR Reference No: 201701-3206-005
Status: Historical Active	Previous ICR Reference No: 201402-3206-002
Agency/Subagency: OPM	Agency Tracking No: RI 25-51
Title: Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/02/2017
	Date Received in OIRA: 05/15/2017
Terms of Clearance: OPM should report this collection in the Information Collection Budget. OPM is asked to review the privacy act statement on the form and to provide the most recent PIA and SORN for the collection when it is next submitted to OMB for renewal.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	6 Months From Approved
Responses	34,800	0	0
Time Burden (Hours)	17,400	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: RI 25-51 will be used by the Civil Service Retirement System solely to pay benefits to the widow(er) of an annuitant. This application is intended for use in immediately authorizing payments to an annuitant's widow or widower, based on the report of death, when our records show the decedent elected to provide benefits for the applicant.

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Authorizing Statute(s): US Code: 5 USC 8341 Name of Law: Survivor Annuitants
   US Code: 5 USC 8342 Name of Law: Lump-Sum Benefits; Designation of Beneficiaries; Order of Precedence
  

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:
	81 FR 47444	07/21/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 21276	05/05/2017
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits	RI 25-51	Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits

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ICR Summary 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	34,800	0	0	0	0	34,800
Annual Time Burden (Hours)	17,400	0	0	0	0	17,400
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $531,200

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 05/15/2017

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