Information Collection

Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits

IC 33746 under ICR 202010-3206-012 · OMB 3206-0233.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 25-51 Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits	Form and Instruction
RI 25-51 Civil Service Retirement System Survivor Annuitant Expre RI25-051_2020_07_Revised.pdf	Form and Instruction

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:

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
Form and Instruction	RI 25-51	Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits_Revised	RI25-051_2020_07_Revised.pdf		No		Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: OPM/Central-1

FR Citation: 73 FR 15013

Number of Respondents: 34,800

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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	34,800	0	0	34,800
Annual IC Time Burden (Hours)	17,400	0	0	17,400
Annual IC Cost Burden (Dollars)	0	-467,625	467,625	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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