SF1153_OMB_Supporting_Stmt_2018

OMB SUPPORTING STATEMENT

SF1153 – Claim for Unpaid Compensation of Deceased Civilian Employee

1. Justification

1. Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information.

Pursuant to the Legislative Branch Appropriations Act of 1996, most of the claims settlement functions performed by the General Accounting Office, now known as the Government Accountability Office (GAO), were transferred to the Director, Office of Management and Budget. See Sec. 211, Pub.L. 104-53, 109 Stat. 535. Subsequently, the Acting Director delegated these functions to various components within the Executive Branch in a determination order dated June 28, 1996. In summary, this order delegated to the U.S. Office of Personnel Management (OPM) the authority to settle claims against the United States involving Federal civilian employees’ compensation and leave, deceased employees’ compensation, and proceeds of cancelled checks for veterans’ benefits payable to deceased beneficiaries. Congress then codified these changes through additional legislation. See Pub.L. 104-316, 110 Stat. 3826. OPM promulgated regulations at title 5, Code of Federal Regulations (CFR), part 178, setting forth detailed procedures for settling claims.

2. Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection.

5 CFR 178.205 (a) directs that the agency at which the deceased employee was last employed request the appropriate person or persons to execute Standard Form (SF) 1153, Claim for Unpaid Compensation of Deceased Civilian Employee. The collection of this information is necessary to assist agencies and OPM with the distribution of deceased employees’ compensation. If this information is not collected, agencies and OPM will have difficulty or be inefficient in distributing these monies to the proper individuals.

In the event of a disputed claim, OPM reviews the information submitted by the claimant and the agency and renders a decision on whether to grant or deny the claim. The decision is documented in a synopsis which explains the facts of the claim and the justification for the decision. The decision is then placed on OPM’s website, with any identifying information removed

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden.

Information collected on the SF 1153 is to be used by the employing agency and, in the event of a disputed claim, by OPM to help determine the claimant’s and others’ rights to the unpaid compensation.

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.

The forms are filed individually. Similar information is not available.

5.  If the collection of information impacts small businesses or other small entities (Item 5 of OMB Form 83-I), describe any methods used to minimize.

This information collection request has no impact on small businesses and organizations.

6. Describe the consequence to Federal/OPM program or policy activities if the collection of information is not conducted, or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.

The collection of this information is performed as needed to assist agencies and OPM with the distribution of deceased employees’ compensation. If this information is not collected, agencies and OPM will have difficulty or be inefficient in distributing these monies to the proper individuals. This could result in OPM making erroneous payments to those who do not qualify for survivor benefits. This information collection is consistent with the guidelines in 5 CFR 1320.6, except for 1320.6(b).

7. Explain any special circumstances that would cause an information collection to be conducted in a manner: On January 22, 2018, a 60 Day Federal Register Notice was published as required by 5 CFR 1320.

There were no comments received.

8. Federal Register Notice: Provide a copy and identify the date and page number of publication in the Federal Register of the agency’s notice soliciting comments on the information collection prior to submission to OMB

The information collection was previously published in the Federal Register on January/22/2018 at Volume # 83 3034-3035 allowing for a 60-day public comment period. No comments were received for this information collection.

9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

No gifts or payments of any kind have been provided to any individuals who are connected to this collection.

10. Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy.

This information collection is protected by the Privacy Act of 1974 and OPM regulations (5 CFR 831.106).

11. Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private. This justification should include the reasons why the agency considers the questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

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. Provide estimates of the hour burden of the collection of information. The statement should:

a. Indicate the number of respondents, frequency of response, annual hour burden, and an explanation of how the burden was estimated. Unless directed to do so, agencies should not conduct special surveys to obtain information on which to base hour burden estimates. Consultation with a sample (fewer than 10) of potential respondents is desired. If the hour burden on respondents is expected to vary widely because of differences in activity, size, or complexity, show the range of estimated hour burden, and explain the reasons for the variance. Generally, estimates should not include burden hours for customary and usual business practices.

b. If this request for approval covers more than one form, provide separate hour burden estimates for each form and aggregate the hour burdens in Item 13 of OMB Form 83-I.

c. Provide estimates of annualized cost to respondents for the hour burdens for collections of information, identifying and using appropriate wage rate categories. The cost of contracting out or paying outside parties for information collection activities should not be included here. Instead, this cost should be included in Item 14.

Approximately 3,000 forms will be processed annually. The form requires approximately 15 minutes for completion. A burden of 750 hours is estimated.

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
Claim for Unpaid Compensation of Deceased Civilian Employee	SF-1153	3,000	1	15 minutes	750	$0	$0

There is no cost to the respondents.

The annualized cost to the Federal government is $30,000. This cost includes employee salary hours devoted to the program, forms and overhead.

13. Provide an estimate of the total annual cost burden to respondents or recordkeepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14.)

The cost estimate should be split into two components: (1) a total capital and start-up cost component (annualized over its expected useful life); and (b) a total operation and maintenance and purchase of services component. The estimates should take into account costs associated with generating, maintaining, and disclosing or providing the information. Include descriptions of methods used to estimate major cost factors including system and technology acquisition, expected useful life of capital equipment, the discount rate(s), and the time period over which costs will be incurred. Capital and start-up costs include, among other items, preparations for collecting information such as purchasing computers and software; monitoring, sampling, drilling and testing equipment; and record storage facilities.

14. If cost estimates are expected to vary widely, agencies should present ranges of cost burdens and explain the reasons for the variance. The cost of purchasing or contracting out information collection services should be a part of this cost burden estimate. In developing cost burden estimates, agencies may consult with a sample of respondents (fewer than 10), utilize the 60-day pre-OMB submission public comment process and use existing economic or regulatory impact analysis associated with the rulemaking containing the information collection as appropriate.

Generally, estimates should not include purchases of equipment or services, or portions thereof, made: (1) prior to October 1, 1995, (2) to achieve regulatory compliance with requirements not associated with the information collection, (3) for reasons other than to provide information to keep records for the government, or (4) as part of customary and usual business or private practices.

There is no change in the respondent burden.

15. Explain the reasons for any program changes or adjustments reported in Items 13 or 14 of the OMB Form 83-I. Changes in hour burden, i.e., program changes or adjustments made to annual reporting and recordkeeping hour and cost burden. A program change is the result of deliberate Federal government action. All new collections and any subsequent revisions of existing collections (e.g., the addition or deletion of questions) are recorded as program changes. An adjustment is a change that is not the result of a deliberate Federal government action. These changes that result from new estimates or actions not controllable by the Federal government are recorded as adjustments.

N/A

16. For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

No information collected from the form will be published.

17. If seeking approval to not display the expiration date for OMB approval of the information collection, explain reasons that display would be inappropriate.

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 information required by long-standing statutory and regulatory 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.  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. Explain each exception to the certification statement identified in Item 19 “Certification for Paperwork Reduction Act Submissions,” of OMB Form 83-I.

There are no exceptions to the certification statement.