Claim for Unpaid Compensation of Deceased Civilian Employee

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SF-1153 Claim for Unpaid Compensation of Deceased Civilian Employee	Form	Removed	Available
Form SF 1153 Claim for Unpaid Compensation of Deceased Civilian Employee	Form and Instruction	New	Available
3206-0234 30day notice.pdf	Supplementary Document	Uploaded 2018-04-17	Available
3206-0234 60 Day Notice.pdf	Supplementary Document	Uploaded 2018-04-17	Available
SF1153_OMB_Supporting_Stmt_2018.docx	Supporting Statement A	Uploaded 2018-05-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33749	Claim for Unpaid Compensation of Deceased Civilian Employee	Form	Removed
231624	Claim for Unpaid Compensation of Deceased Civilian Employee	Form and Instruction	New

ICR Details

OMB Control No: 3206-0234	ICR Reference No: 201804-3206-004
Status: Active	Previous ICR Reference No: 201503-3206-002
Agency/Subagency: OPM	Agency Tracking No:
Title: Claim for Unpaid Compensation of Deceased Civilian Employee
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/12/2018
	Date Received in OIRA: 04/27/2018
Terms of Clearance: This collection is approved based upon the revised materaisl provided by the Agency.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	36 Months From Approved	06/30/2018
Responses	3,000	0	3,000
Time Burden (Hours)	750	0	750
Cost Burden (Dollars)	0	0	0

---

Abstract: 5 CFR 178.205(a) directs the agency in which a deceased employee was last employed to request, in the order of payment precedence outlined in 5 CFR 178.204, the appropriate person or persons to execute Standard Form 1153, "Claim for Unpaid Compensation of Deceased Civilian Employee." The information collected on this form is needed by the employing agencies and, in the event of a disputed claim, by OPM to help determine the claimant's and others' rights to the unpaid compensation of the deceased employee. 31 USC 3702 authorizes the Director of the Office of Personnel Management (OPM) to settle claims involving Federal civilian employees' compensation and leave. OMB promulgated regulations at 5 CFR 178 describing general procedures applicable to claims against the United States that may be settled by the OPM Director.

---

Authorizing Statute(s): US Code: 31 USC 3702 Name of Law: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 3034	01/22/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 15423	04/10/2018
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Claim for Unpaid Compensation of Deceased Civilian Employee	SF 1153	Claim for Unpaid Compensation of Deceased Civilian Employee
Claim for Unpaid Compensation of Deceased Civilian Employee	SF-1153	Claim for Unpaid Compensation of Deceased Civilian Employee

---

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	3,000	3,000	0	3,000	-3,000	0
Annual Time Burden (Hours)	750	750	0	750	-750	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: Previous version removed but is still showing above.

---

Annual Cost to Federal Government: $30,000

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.     No

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

---

Common Form ICR:  Yes

Description/Changes for Common Form Usage: 

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

---

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: 04/27/2018

---