Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form RI 20-63 Survivor Annuity Election for a Spouse	Form and Instruction	Modified	Available
Form RI 20-63 Survivor Annuity Election for a Spouse	Form and Instruction	Modified	Available
Form RI 20-117 Information about the Cost to Elect teh Maximum Survivor Annuity	Form and Instruction	Modified	Available
Form RI 20-117 Information about the Cost to Elect teh Maximum Survivor Annuity	Form and Instruction	Modified	Available
Form RI 20-116 Information about the Cost to Elect Less Than the Maximum Survivor Annuity	Form and Instruction	Modified	Available
Form RI 20-116 Information about the Cost to Elect Less Than the Maximum Survivor Annuity	Form and Instruction	Modified	Available
Form RI 20-63 Survivor Annuity Election for a Spouse	Form and Instruction	Modified	Available
E8-5659.pdf	Supplementary Document	Uploaded 2017-12-29	Available
RI 20-63 Regulations.pdf	Supplementary Document	Uploaded 2017-12-29	Available
RI20-063_30DayFRNPublished_2017_12_11.pdf	Supplementary Document	Uploaded 2017-12-29	Available
RI20-063_60dayFRN_Published_2017_05_08.pdf	Supplementary Document	Uploaded 2017-12-29	Available
RI20-063_OMB_SuppStmt_2018_01_18.docx	Supporting Statement A	Uploaded 2018-01-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33658	Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....	Form and Instruction	Modified	Survivor Annuity Election for a Spouse
33658	Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....	Form and Instruction	Modified	Survivor Annuity Election for a Spouse
33658	Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....	Form and Instruction	Modified	Information about the Cost to Elect teh Maximum Survivor Annuity
33658	Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....	Form and Instruction	Modified	Information about the Cost to Elect teh Maximum Survivor Annuity
33658	Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....	Form and Instruction	Modified	Information about the Cost to Elect Less Than the Maximum Survivor Annuity
33658	Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....	Form and Instruction	Modified	Information about the Cost to Elect Less Than the Maximum Survivor Annuity
33658	Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....	Form and Instruction	Modified	Survivor Annuity Election for a Spouse

ICR Details

OMB Control No: 3206-0174	ICR Reference No: 201712-3206-015
Status: Historical Active	Previous ICR Reference No: 201607-3206-006
Agency/Subagency: OPM	Agency Tracking No: RI 20-63/RI 20-116/RI 20-117
Title: Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/05/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/29/2017
Terms of Clearance: This collection is approved based on the revised materials provided by the Agency.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved	02/28/2018
Responses	2,400	0	2,400
Time Burden (Hours)	1,834	0	1,834
Cost Burden (Dollars)	0	0	0

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Abstract: RI 20-63 is used by annuitants to elect a reduced annuity with a survivor annuity for their spouse. RI 20-116 and 20-117 are cover letters that give the cost of the election. RI 20-117 may be used to ask for more information or to decline to elect. RI 20-116 may be used to decline to elect.

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Authorizing Statute(s): US Code: 5 USC 8416(b) and (c) Name of Law: Survivor reduction for a current spouse
   US Code: 5 USC 8339(j)(5)(C)(i) and (k)(2) Name of Law: Computation of Annuity
  

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:
	82 FR 21433	05/08/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 58225	12/11/2017
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
Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....	RI 20-63, RI 20-63, RI 20-116, RI 20-63, RI 20-116, RI 20-117, RI 20-117	Survivor Annuity Election for a Spouse ,   Information about the Cost to Elect Less Than the Maximum Survivor Annuity ,   Information about the Cost to Elect Less Than the Maximum Survivor Annuity ,   Information about the Cost to Elect teh Maximum Survivor Annuity ,   Information about the Cost to Elect teh Maximum Survivor Annuity ,   Survivor Annuity Election for a Spouse ,   Survivor Annuity Election for a Spouse

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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	2,400	2,400	0	0	0	0
Annual Time Burden (Hours)	1,834	1,834	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: $142,800

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: 12/29/2017

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