RI 38-117, Rollover Election, RI 37-118, Rollover Information, and RI 37-22, Special Tax Notice Regarding Rollovers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form RI 38-117 RI 38-117, Rollover Election	Form and Instruction	Modified	Available
E8-5659.pdf	Supplementary Document	Uploaded 2019-04-30	Available
OMB RI 38-117 2019 Supporting Statement_Revised.doc	Supporting Statement A	Uploaded 2019-04-30	Available
RI38-117_30DayFRNPublished_2019_03_12.pdf	Supplementary Document	Uploaded 2019-04-30	Available
RI 38-117 60-Day Published_2018_12_04.pdf	Supplementary Document	Uploaded 2019-04-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33708	RI 38-117, Rollover Election	Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0212	ICR Reference No: 201904-3206-001
Status: Active	Previous ICR Reference No: 201510-3206-003
Agency/Subagency: OPM	Agency Tracking No: RI 38-117, RI 37-118 and RI 37-22
Title: RI 38-117, Rollover Election, RI 37-118, Rollover Information, and RI 37-22, Special Tax Notice Regarding Rollovers
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: 07/08/2019
	Date Received in OIRA: 05/30/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2022	36 Months From Approved	08/31/2019
Responses	1,500	0	1,500
Time Burden (Hours)	1,000	0	1,000
Cost Burden (Dollars)	60,249	0	0

---

Abstract: RI 38-117, Rollover Election, is used to collect information from each payee affected by a change in the tax code so that OPM can make payment in accordance with the wishes of the payee. RI 38-118, Rollover Information, explains the election. RI 37-22, Special Tax Notice Regarding Rollovers, provides more detailed information. Privacy Act Statements have been added to RI 38--117 and RI 37-22.The Privacy Act Statement for RI 38--117 has been revised due to a general systematic review by our Chief Privacy Officer.

---

Authorizing Statute(s): US Code: 5 USC 8432(j)(2) Name of Law: Lump-sum benefits; designation of beneficiary; order of precedence
   PL: Pub.L. 107 - 147 411 Name of Law: Amendments related to Economic Growth and Tax Relief Reconciliation Act of 2001
   PL: Pub.L. 107 - 16 643 Name of Law: Rollovers of after-tax contributions
   PL: Pub.L. 107 - 16 641 Name of Law: Rollovers allowed among various types of plans
   US Code: 26 USC 402(f) and 402(c)(2) Name of Law: Taxability of beneficiary of employees' trust
  

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 62630	12/04/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 8917	03/12/2019
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
RI 38-117, Rollover Election	RI 38-117, RI 38-118, RI 38-117, RI 38-118, RI 37-22, RI N37-22	Rollover Election ,   Rollover Information ,   Rollover Election ,   Rollover Information ,   Special Tax Notice Regarding Rollovers ,   Special Tax Notice Regarding Rollovers

---

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	1,500	1,500	0	0	0	0
Annual Time Burden (Hours)	1,000	1,000	0	0	0	0
Annual Cost Burden (Dollars)	60,249	0	0	0	60,249	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $8,500

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

---

Common Form ICR:  No

---

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: 05/30/2019

---