Information Collection

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

IC 218450 under ICR 201911-3206-002 · OMB 3206-0270.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
RI76-010_MarkUp.pdf RI 76-10_MarkUp	IC Document
RI76-10_Revised.pdf RI 76-10 Revised	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 8706

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records

Title: OPM/Central-1

FR Citation: 73 FR 15013

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	400	0	400
Annual IC Time Burden (Hours)	100	0	100
Annual IC Cost Burden (Dollars)	2,685	2,685	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
RI 76-10_MarkUp	RI76-010_MarkUp.pdf	11/08/2019
RI 76-10 Revised	RI76-10_Revised.pdf	11/13/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.