OMB SUPPORTING STATEMENT
SF 2800 Application for Death Benefits (CSRS)
SF 2800A Documentation and Elections in Support of Application for Death Benefits
When Deceased Was an Employee at the Time of Death
SF 2800-1 Applying for Death Benefits under the Civil Service Retirement System
Justification
Title 5, U. S. Code, Chapter 83, Sections 8341 and 8342 provide for two types of death benefits: survivor benefits and lump-sum payments. Survivor annuities may be payable to a spouse, former spouse, and eligible dependent children upon the death of an employee or annuitant. A lump-sum benefit may be payable upon the death of an employee, former employee, or annuitant if no spouse, former spouse, or eligible dependent children are entitled to survivor annuity or, if a survivor annuity is payable, after the right of the last person entitled thereto has terminated. These benefits cannot be paid unless application for the benefits is made to the Office of Personnel Management (OPM). Title 5, U. S. Code, Section 8347(b) authorizes OPM to prescribe the application formats needed.
The information collected by these applications is used by the Civil Service Retirement System to authorize payment of benefits in the event of the death of an employee, a former employee, or an annuitant. SF 2800 collects information from the survivors of deceased employees and deceased annuitants. SF 2800A collects information needed from survivors of employees who die in service. This information is already available if the deceased is an annuitant. Every applicant who uses SF 2800 should read SF 2800-1, Applying for Death Benefits under CSRS. This brief booklet provides the general information applicants need to understand what they are applying for. There are minor editorial changes to this information collection and the Public Burden Statement. The Privacy Act Statement has been revised due to a general systematic review by our Chief Privacy Officer.
The information collected is detailed and can only be obtained from the respondents. New methods of information technology would do little to reduce the burden on the respondents; they must sign the application attesting to its truth, under penalty of law, to the best of their knowledge. However, this form is available in a PDF fillable format on our website and meets the GPEA requirements.
Applications are filed individually. There is no similar information available. Duplication is minimized.
This information collection request has no impact on small businesses and organizations.
Information collection is required upon the death of an employee, a former employee, or an annuitant. Less frequent collections would delay the award of benefits authorized by title 5, U. S. Code, Chapter 83. This collection is consistent with the guidelines of 5 CFR 1320.6.
There are no special circumstances involved in the collection of this information.
On November 21, 2017, a 60 Day Federal Register Notice was published at 82 FR 55422. There were no comments 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.
Approximately 40,000 SF 2800s are processed annually. This form
requires
approximately forty-five minutes for completion
including the time required to verify the
information
requested. A burden of 30,000 hours is estimated.
Approximately 400 applicants will use SF 2800A annually. This form also requires approximately forty-five minutes for completion giving a burden of 300 hours.
The total burden for these forms is 30,300 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 |
Application for Death Benefits Under CSRS Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee at the Time of Death (CSRS) |
SF 2800
SF 2800A |
40,000
400 |
1
1 |
45 minutes
45 minutes |
30,000
300 |
$0
$0 |
$0
$0 |
There is no cost to the respondents.
13. There is no change in the respondent burden.
14. The annualized cost to the Federal government is $1,325,300.
This cost was determined
by employee salary hours
devoted to the program, forms cost, and overhead.
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 |