RI 76-10 Assignment, Federal Employees' Group Life Insurance (FEGLI) Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
E8-5659.pdf	Supplementary Document	Uploaded 2019-11-13	Available
RI76-10_30DayPublished_2019_11_08.pdf	Supplementary Document	Uploaded 2019-11-13	Available
RI76-010_60DayFRNPublished_2019_04_17.pdf	Supplementary Document	Uploaded 2019-11-08	Available
RI 76-10 Supporting Statement_2020_Revised.docx	Supporting Statement A	Uploaded 2020-02-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218450	RI 76-10 Assignment, Federal Employees' Group Life Insurance (FEGLI) Program		Modified

ICR Details

OMB Control No: 3206-0270	ICR Reference No: 201911-3206-002
Status: Historical Active	Previous ICR Reference No: 201510-3206-001
Agency/Subagency: OPM	Agency Tracking No: RI 76-10 Assignment, Federal Employees' Group Life
Title: RI 76-10 Assignment, Federal Employees' Group Life Insurance (FEGLI) Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/27/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/30/2019
Terms of Clearance: This collection is approved based on the revised materials provided by the Agency.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2023	36 Months From Approved	02/29/2020
Responses	400	0	400
Time Burden (Hours)	100	0	100
Cost Burden (Dollars)	2,685	0	0

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Abstract: RI 76-10 allows an insured individual to transfer ownership, or “assign” the FEGLI coverage, to a third party. An insured may assign for several reasons; for example, for financial planning purposes, or to comply with a court order, or to sell the coverage to a third-party. Unlike a designation of beneficiary, once an assignment is executed, it is irrevocable. The Privacy Act Statement has been revised due to a systematic review by our Chief Privacy Officer.

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Authorizing Statute(s): US Code: 5 USC 8706 Name of Law: Termination of Insurance; assignment owership
  

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:
	84 FR 16050	04/17/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 60460	11/08/2019
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
RI 76-10 Assignment, Federal Employees' Group Life Insurance (FEGLI) Program

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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	400	400	0	0	0	0
Annual Time Burden (Hours)	100	100	0	0	0	0
Annual Cost Burden (Dollars)	2,685	0	0	0	2,685	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:

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Annual Cost to Federal Government: $30,760

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: 11/30/2019

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