Self-Certification of Full-Time School Attendance

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form RI 25-14A Self-Certification of Full-Time School Attendance	Form and Instruction	Unchanged	Available
RI 25-14 Published 60 Day FRN.pdf	Supplementary Document	Uploaded 2017-03-23	Available
RI25-014_30DayFRN_Published_2017_03_14.pdf	Supplementary Document	Uploaded 2017-03-23	Available
RI 25-14 SS.doc	Supporting Statement A	Uploaded 2017-03-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33544	Self-Certification of Full-Time School Attendance	Form and Instruction	Unchanged

ICR Details

OMB Control No: 3206-0032	ICR Reference No: 201703-3206-008
Status: Historical Active	Previous ICR Reference No: 201401-3206-005
Agency/Subagency: OPM	Agency Tracking No:
Title: Self-Certification of Full-Time School Attendance
Type of Information Collection: Extension without change of a currently 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: 03/27/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	09/30/2017
Responses	14,000	0	14,000
Time Burden (Hours)	2,800	0	2,800
Cost Burden (Dollars)	0	0	0

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Abstract: RI 25-14 is used to survey survivor annuitants who are between the ages of 18 and 22 to determine if they meet the requirements of Section 8341(a)(4)(C), and Section 8441, title 5, U.S. Code, to receive benefits as a student.

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Authorizing Statute(s): US Code: 5 USC 83, Section 8341 Name of Law: Survivor Annuities
   US Code: 5 USC 84, Section 8441 Name of Law: Definitions
  

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 64956	09/21/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 48	03/14/2017
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Self-Certification of Full-Time School Attendance	RI 25-14, RI 25-14A	Information and Instructions for Completing the Self-Certification of Full-Time School Attendance For The School Year ,   Self-Certification of Full-Time School Attendance For The School Year

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ICR Summary of Burden

table that charts list 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	14,000	14,000	0	0	0	0
Annual Time Burden (Hours)	2,800	2,800	0	0	0	0
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: $35,300

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: 03/27/2017

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