OMB SUPPORTING STATEMENT
SF 2817 – Life Insurance Election Form
Justification
Chapter 87 of title 5, United States code, authorizes the Office of Personnel Management (OPM) to administer the Federal Employees’ Group Life Insurance Program, and to issue regulations to carry out the provisions of the FEGLI law. The law and regulations specify that at the time an individual is hired, he or she is automatically enrolled in Basic insurance, and he/she has the opportunity to elect optional insurance. In addition, there are other circumstances and opportunities to enroll or change one’s enrollment. Standard Form 2817 – Life Insurance Election – is the form that eligible individuals use to enroll or change enrollment status under the FEGLI Program.
The SF 2817 is used by Federal employees and assignees (those who have acquired control of an employee/annuitant’s coverage through an assignment or “transfer” of the ownership of the life insurance). Clearance of this form for use by active Federal employees is not required according to the Paperwork Reduction Act (P.L. 98-615). Therefore, only the use of this form by assignees, i.e. members of the public, is subject to the Paperwork Reduction Act. The Privacy Act Statement (PAS) has been revised due to a general systematic review and by our Chief Privacy Officer for all OPM PAS.
We continue to explore new and innovative methods of information technology to collect the information from employees, although that is not the audience for this request. While agencies have begun the use of information technology to process life insurance elections, it is not currently available to allow non-Federal employee assignees to utilize this same technology. As a result, we do not believe the process would be any less burdensome than it currently is. Completion of the SF 2817 is a voluntary action by the respondent, and the information collected can only be obtained from the respondent. This form is available in a PDF format on our website and meets our GPEA requirements.
Every effort is made to identify and avoid duplication, and its occurrence is unlikely. Respondents (i.e., assignees) are never required to complete the form. The form is only completed when the assignee voluntarily chooses to reduce the insured’s life insurance coverage.
This information collection request has no impact on small businesses and organizations.
If this information is not collected, respondents (assignees) cannot reduce the insured's’ current level of FEGLI coverage. The only way to reduce the burden would be to restrict the assignee’s ability to make changes to the enrollment. This would require a statutory and regulatory change.
This information collection is voluntary. Respondents aren’t required to report information-it is their choice to do so. However, in declining to provide information, the FEGLI enrollment may not be what they want. Respondents may report information more often than quarterly-it depends on their individual circumstances. There is no way to predict or control how often changes are requested.
Respondents complete the SF 2817, which includes the original and two carbon (or locally downloaded and printed) copies. The [carbon] copies are necessary to document the Official Personnel Folder (OPF) or case file, to notify the respective payroll office, and to provide the respondent a copy certified by the agency.
This collection is consistent with the guidelines of 5 CFR 1320.6.
There are no special circumstances involved in the collection of this information.
A 60-day Federal Register Notice of proposed information collection was published in the Federal Register on May 26, 2017, as required by 5 CFR 1320, giving persons outside the agency an opportunity to comment on this form. No comments were received.
No gifts or payments of any kind have been provided to any individuals who are connected to this collection.
This information collection is protected by the Privacy Act of 1974 and OPM regulations (5 CFR 831.106). The routine uses of disclosure appear in the Federal Register for OPM/Central-1 (73 FR 15013, et seq., March 20, 2008, effective April 21, 2008).
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 150 SF 2817 forms will be processed each year from
assignees. It is
almost always in an assignee’s
best interests to keep the insured’s life insurance coverage
at its current level. It is rarely beneficial for an assignee
to reduce or cancel such
coverage-the only instance in
which the assignee would use the form since new or
increased coverage cannot be elected by the assignee. We estimate
the SF 2817 requires
approximately 15 minutes for a
respondent to read the instructions and complete.
Therefore, the estimated annual burden is 38 hours.
Form Name |
Form Number |
No. of Respondents |
No. of Responses per Respondent |
Average Burden per Response (in hours) |
Total Annual Burden (in hours) |
Average Hourly Wage Rate |
Total Annual Respondent Cost |
Life Insurance Election Form |
SF 2817 |
150 |
1 |
15 minutes |
37.50 |
$0 |
$0 |
There is no cost to the respondents or record keepers resulting from the collection of this information.
13. There is no change in the respondent burden.
14. The annualized cost to the government for the printing and
distributing this form to the
assignees (estimated 150)
is negligible. It is our efforts to continue to go green; we are
printing a limited numbers of forms. Most individuals and
agencies can download the
form locally instead.
Therefore, we estimate no reportable expenses incurred in the
collection of this information.
15. N/A
16. No information collected from the form will be published.
17.
The Retirement Services program office is the lone processor of the
data collected on
these ICRs from approximately 2.8
million customers. The substance of each information
collection does not substantively change at each OMB renewal cycle,
but according to
changes in law and regulation. These
forms are printed and published (internet, intranet
and
on-board systems) through various agencies for distribution to and
implementation
by Government customers. Pursuant to title
5 CFR 1320.8(b)(1), it would not be
appropriate to
display the OMB clearance expiration date where the form will not be
revised for the foreseeable future (e.g., because it is used to
collect applicant, annuitant,
or beneficiary information
required by long-standing statutory provisions), where use of
the paper form is prevalent, and where, accordingly, it will be
expensive and burdensome
to restock the paper forms
inventory with a new version. Last year, under current practice,
Retirement Services printed approximately 2 million documents
subject to OMB
clearance at a cost of approximately
$85,000. Our costs would rise substantially if
additional
revision cycles are added. Lastly, by adding the OMB clearance
expiration date
to the existing format, the end users of
OPM’s ICRs may erroneously assume that the
expiration
date affects the validity of the information collection when it is
the OMB
clearance expiration date and not reflective of the
substance. This may lead to additional
submissions by
customers, possible litigation and increasing pressures on our
Operations
workloads. Therefore, we seek approval to not
display the OMB clearance expiration date
on the forms and
to communicate version changes to the public via the revision date.
18. There are no exceptions to the certification statement.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | OMB SUPPORTING STATEMENT |
| Author | MEMOORE |
| File Modified | 0000-00-00 |
| File Created | 2021-01-21 |