OPM1530_OMBSupportStmt_2017_04_11

OMB SUPPORTING STATEMENT

OPM Form 1530 – Report of Medical Examination of Person Electing Survivor Benefits under the Civil Service Retirement System

A. Justification

1. Title 5, U. S. Code, Section 8339(k)(1) provides that an employee in good health who is applying for a non-disability annuity, may elect at the time of retirement, a reduced annuity in order to provide a survivor benefit for a person who has an insurable interest. An insurable interest exists if the survivor is a person who would suffer financially because of the death of the retiree.

2. When an employee elects an insurable interest survivor annuity, the Office of Personnel Management requires that the applicant provide evidence of a recent medical examination to verify their good health. OPM Form 1530 is designed to collect information from both the applicant and the applicant’s physician regarding the applicant’s health. This information is used to determine whether the insurable interest survivor benefits election can be allowed. The form has been revised to bring it up-to-date. Specifically, solicitation of this information is also authorized by the Federal Employees Retirement System (Chapter 84, title 5, United States Code). The Public Burden Statement meets the requirements of 5 CFR 1320.8(b)(3).

2. The information collected is detailed and can only be obtained from the respondents. New methods of information technology would do little to reduce the burden on the respondents. However, this form is available in a pdf fillable format on our website and meets our GPEA requirements.

2. Applications are filed individually. There is no duplication because the respondents initiate the collection.

2. Information is not collected from small businesses.

2. The collection of this information is performed as needed to grant the survivor reduction to eligible persons. Less frequent collection would deny this benefit which is provided by law.

2. This collection is consistent with the guidelines of 5 CFR 1320.6.

2. A notice of proposed information collection was published in the Federal Register on, August 10, 2016, giving persons outside the agency an opportunity to comment on the forms. No comments were received.

2. No payment or gift is provided to these respondents.

Page 2

2. This information collection is protected by the Privacy Act of 1974 and OPM regulations (5 CFR 831.106 and 5 CFR 841.108). The routine uses for disclosure appear in the Federal Register for OPM/Central-1 (73 FR 15013, et seq., March 20, 2008).

2. The information collection does not include questions regarding sexual behavior and attitudes or religious beliefs, and other matters that are commonly considered private. However, the collection does include questions about the health and physical condition of the applicant because these matters are fundamental to the decision as to whether to allow the insurable interest survivor election.

2. Approximately 500 annuitants apply to elect an insurable interest survivor annuity each year. The form requires approximately one hour and 30 minutes to complete. This includes the time needed to undergo a physical examination and enter the results on the form. A burden of 750 hours is estimated and is not expected to vary substantially.

2. A physician’s report is required to document the state of the applicant’s health. There is no way to estimate the cost to the respondent because the respondent may or may not have had a recent physical examination on which to base the physician’s report.

2. The annualized cost to the Federal government is $24,150. This cost includes employee salary hours devoted to the program, forms cost, and overhead.

2. There is no change to the respondent burden.

2. The results of this information collection are not published.

2. It is not cost-effective to reprint the whole supply of forms to change the OMB clearance expiration date. Therefore, we seek approval not to display the OMB expiration date on the form.

2. There are no exceptions to the certification statement.

B. Collection of Information Employing Statistical Methods

This information collection does not employ statistical methods.