Information Collection

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

IC 33746 under ICR 201701-3206-005 · OMB 3206-0233.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0233 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 25-51 Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits	Form and Instruction
RI 25-51 Civil Service Retirement System Survivor Annuitant Expre RI 25-051 May 2011.pdf	Form and Instruction

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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
Form and Instruction	RI 25-51	Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits	RI 25-051 May 2011.pdf		No		Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: OPM/Central-1

FR Citation: 73 FR 15013

Number of Respondents: 34,800

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	34,800	34,800
Annual IC Time Burden (Hours)	17,400	17,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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