RI20-064_OMB_Supporting_Statement_csb_2016_11_14

OMB SUPPORTING STATEMENT
RI 20-64
RI 20-64A
RI 20-64B

- Letter Reply to Request for Information
- Former Spouse Survivor Annuity Election
- Information on Electing a Survivor Annuity for Your Former Spouse

A. Justification
1. Title 5, U. S. Code, Section 8339(j)(3) and Section 8417 state that annuitants may elect,
after retirement, to provide survivor annuity benefits for a former spouse.
2. RI 20-64 is used by the Civil Service Retirement System to provide information about the
amount of annuity payable after a survivor reduction, to explain the annuity reductions
required to pay for the survivor benefit, and to give the beginning rate of survivor
annuity. RI 20-64A is used to make the election, and RI 20-64B, an information booklet,
are enclosed. This group of forms is needed to obtain an informed survivor benefits
election from annuitants who are eligible to elect to provide survivor benefits for a former
spouse. Using RI 20-64A, the annuitant may elect the survivor benefit, obtain any
current spouse’s consent to the election, or decline to make the election. RI 20-64 has a
space the annuitant may use to ask for information about electing less than the maximum
survivor benefit. OPM could not comply with title 5 if this information were not
collected. The Public Burden Statement meets the requirement of 5 CFR 1320.8(b)(3).
3. New methods of information technology would do little to reduce the burden on the
respondents. They must sign the election form. This form is available in a PDF fillable
format on our website and meets our GPEA requirements.
4. Elections are filed individually. Similar information certified by the respondent is not
available. Duplication is minimized.
5. Information is not collected from small businesses.
6. If this information were not collected, annuitants would be unable to elect survivor
benefits provided by law.
7. This information collection is consistent with the guidelines in 5 CFR 1320.6.
8. A notice of proposed information collection was published in the Federal Register on
September 21, 2016, giving persons outside the agency an opportunity to comment on the
form. No comments were received.
9. No payment or gift is provided to these respondents.

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10. This information collection is protected by the Privacy Act of 1974 and OPM regulations
(5 CFR 831.106). The routine uses for disclosure appear in the Federal Register for
OPM/Central-1 (73 FR 15013, et seq., March 20, 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. We estimate that 30 survivor elections on RI 20-64A will be processed per year and that
of these 8 will use RI 20-64 to ask for information about electing a smaller survivor
benefit. Form RI 20-64A requires 45 minutes to complete for a burden of 23 hours.
Form RI 20-64 requires 8 minutes to complete for a burden of one hour. The total burden
is 24 hours.
13. There is no cost to the respondent.
14. The annualized cost to the Federal government is $1,412. This cost includes employee
salary hours devoted to the program, forms cost, and overhead.
15. There is no change in the respondent burden.
16. The results of this information collection are not published.
17. 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 date on the form.
18. There are no exceptions to the certification statement.