RI 34-1, 34-17, Financial Resources Questionnaire, RI 34-3, RI 34-19, Notice of Amount Due Because of Annuity Overpayment and RI 34-20, Notice of Amount Due Because of FEHB Premium Underpayment.

Forms and Documents

Document Name	Status
Form RI 34-20 Notices of Amount Due Because of Annuity Overpayment Form and Instruction	Modified
Citations.pdf Supplementary Document	2018-05-08
E8-5659.pdf Supplementary Document	2018-05-08
RI 34-001_OMB_Supporting_Stmt_2018_06_05.docx Supporting Statement A	2018-06-27
RI 34-001_60 Day_FRN_Published.pdf Supplementary Document	2018-05-08
RI 34-001_Published_30Day_FRN.pdf Supplementary Document	2018-05-08

IC Document Collections

IC ID	Document Title	Status
33642	Notices of Amount Due Because of Annuity Overpayment Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0167	ICR Reference No: 201803-3206-008
Status: Historical Active	Previous ICR Reference No: 201502-3206-005
Agency/Subagency: OPM	Agency Tracking No: RI 34-1, 34-3, 34-17, 34-18, 34-19, 34-20
Title: RI 34-1, 34-17, Financial Resources Questionnaire, RI 34-3, RI 34-19, Notice of Amount Due Because of Annuity Overpayment and RI 34-20, Notice of Amount Due Because of FEHB Premium Underpayment.
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/13/2018
	Date Received in OIRA: 06/28/2018
Terms of Clearance: OPM should consider if this collection of forms should be converted to a common form.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2021	36 Months From Approved	08/31/2018
Responses	2,361	0	2,081
Time Burden (Hours)	2,361	0	2,081
Cost Burden (Dollars)	0	0	0

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Abstract: The Notice of Amount Due Because of Annuity Overpayment (RI 34-3); the Notice of Amount Due Because of FEGLI Premium Underpayment (RI 34-19); and the Notice of Amount Due Because of FEHB Premium Underpayment (RI 34-20) are used to notify individuals about overpaid benefits and the intent of OPM to collect the overpayment. The Financial Resources Questionnaire forms (RI 34-1, RI 34-17, and RI 34-18) are used to collect financial data from overpaid individuals. Changes include: Adding payment location, updating correspondence mailing address and updating the Privacy Act Statement.

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Authorizing Statute(s): US Code: 31 USC Section 3716 Name of Law: Administrative Offset
  

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 51883	11/08/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 19845	05/04/2018
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Notices of Amount Due Because of Annuity Overpayment	RI 34-3, RI 34-1, RI 34-17, RI 34-18, RI 34-20, RI 34-19, RI 34-1 , RI 34-3 , RI 34-17, RI 34-18, RI 34-19, RI 34-20	Notice of Amount Due Because of FEHB Premium Underpayment (Markup) ,   Financial Resources Questionnaire ,   Financial Resources Questionnaire ,   Notice of Amount Due Because of FEGLI Premium Underpayment ,   Notice OF Amount Due Because of FEHB Premium Underpayment ,   Financial Resources Questionnaire ,   Notice of Amount Due Because of Annuity Overpayment ,   Financial Resources Questionnaire (Markup) ,   Notice of Amount Due Because of Annuity Overpayment (Markup) ,   Financial Resources Questionnaire (Markup) ,   Financial Resources Questionnaire (Markup) ,   Notice of Amount Due Because of FEGLI Premium Underpayment (Markup)

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ICR Summary 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	2,361	2,081	0	280	0	0
Annual Time Burden (Hours)	2,361	2,081	0	280	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is a change to the respondent burden, due to a program change. Forms RI 34-18 and RI 34-20 have been added.

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Annual Cost to Federal Government: $126,000

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: 06/28/2018

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