SF 2823, Designation of Beneficiary - Federal Employees' Group Life Insurance Program (FEGLI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SF 2823 Designation of Beneficiary, Federal Employees' Group Life Insurance Program_Revised	Form and Instruction	Modified	Available
SF2823_2014_05_MarkUp.pdf	Supplementary Document	Uploaded 2020-10-22	Available
E8-5659.pdf	Supplementary Document	Uploaded 2020-10-22	Available
SF2823_60DayFRNPublished_2020_03_09.pdf	Supplementary Document	Uploaded 2020-10-22	Available
SF2823_30DayFRNPublished_2020_10_07.pdf	Supplementary Document	Uploaded 2020-10-22	Available
SF 2823 Supporting Statement.docx	Supporting Statement A	Uploaded 2020-10-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33600	Designation of Beneficiary - Federal Employees' Group Life Insurance Program (FEGLI)	Form and Instruction	Modified	Designation of Beneficiary, Federal Employees' Group Life Insurance Program_Revised

ICR Details

OMB Control No: 3206-0136	ICR Reference No: 202010-3206-015
Status: Historical Active	Previous ICR Reference No: 201703-3206-010
Agency/Subagency: OPM	Agency Tracking No: SF 2823
Title: SF 2823, Designation of Beneficiary - Federal Employees' Group Life Insurance Program (FEGLI)
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: 12/22/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/02/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2023	36 Months From Approved	12/31/2020
Responses	48,000	0	48,000
Time Burden (Hours)	12,000	0	12,000
Cost Burden (Dollars)	0	0	0

---

Abstract: Standard Form 2823 is used by any Federal employee or retiree covered by the Federal Employees' Group Life Insurance (FEGLI) Program, or an assignee who owns an insured's coverage, to instruct the Office of Federal Employees' Group Life Insurance how to distribute the proceeds of the FEGLI coverage when the statutory order of precedence does not meet his or her needs. The Privacy Act Statement has been revised due to a systematic review by our Chief Privacy Officer.

---

Authorizing Statute(s): US Code: 5 USC Section 8705, Subpart G Name of Law: Insurance and Annuities
  

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:
	85 FR 13678	03/09/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 63301	10/07/2020
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Designation of Beneficiary - Federal Employees' Group Life Insurance Program (FEGLI)	SF 2823	Designation of Beneficiary, Federal Employees' Group Life Insurance Program_Revised

---

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	48,000	48,000	0	0	0	0
Annual Time Burden (Hours)	12,000	12,000	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	-2,685	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:

---

Annual Cost to Federal Government: $12,700

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? No

---

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: 11/02/2020

---