Annuity Supplement Earnings Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form RI 92-22 Annuity Supplement Earnings Report	Form and Instruction	Modified	Available
Form RI 92-22 Annuity Supplement Earnings Report	Form and Instruction	Modified	Available
Form RI 92-22 Annuity Supplement Earnings Report	Form and Instruction	Modified	Repair queued
RI92-022_OMBSupportingStmt_2021_01_28rev.docx	Supporting Statement A	Uploaded 2021-01-28	Repair queued
RI92-022_2021_03_MarkUp.pdf	Supplementary Document	Uploaded 2021-01-28	Repair queued
RI92-022_2019_03_MarkUp.pdf	Supplementary Document	Uploaded 2021-01-28	Repair queued
RI92-022_Citations.pdf	Supplementary Document	Uploaded 2021-01-28	Repair queued
FACES 2017 FINAL 12212017signed.pdf	Supplementary Document	Uploaded 2021-01-28	Repair queued
ARS PIA Final 12212017signed.pdf	Supplementary Document	Uploaded 2021-01-28	Repair queued
2021-01826.pdf	Supplementary Document	Uploaded 2021-01-28	Repair queued
RI92-022_60DayFRNPublished_2020_04_07.pdf	Supplementary Document	Uploaded 2021-01-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33678	Annuity Supplement Earnings Report	Form and Instruction	Modified	Annuity Supplement Earnings Report
33678	Annuity Supplement Earnings Report	Form and Instruction	Modified	Annuity Supplement Earnings Report
33678	Annuity Supplement Earnings Report	Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0194	ICR Reference No: 202101-3206-003
Status: Historical Active	Previous ICR Reference No: 201903-3206-001
Agency/Subagency: OPM	Agency Tracking No: RI 92-22
Title: Annuity Supplement Earnings Report
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: 03/20/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/28/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2024	36 Months From Approved	03/31/2021
Responses	13,000	0	13,000
Time Burden (Hours)	3,250	0	3,250
Cost Burden (Dollars)	87,282	0	0

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Abstract: RI 92-22, Annuity Supplement Earnings Report, is used each year to obtain the earned income of Federal Employees Retirement System (FERS) annuitants receiving an annuity supplement. The annuity supplement is paid to eligible FERS annuitants who are not retired on disability and are not yet age 62. The supplement approximates the portion of a full career Social Security benefit earned while under FERS and ends at age 62. Like Social Security benefits, the annuity supplement is subject to an earnings limitation.

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Authorizing Statute(s): US Code: 5 USC Chapter 84, Section 8421 Name of Law: FERS, Annuity Supplement
  

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:
	85 FR 19518	04/07/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 7425	01/28/2021
Did the Agency receive public comments on this ICR? Yes

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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
Annuity Supplement Earnings Report	RI 92-22, RI 92-22	Annuity Supplement Earnings Report ,   Annuity Supplement Earnings Report

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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	13,000	13,000	0	0	0	0
Annual Time Burden (Hours)	3,250	3,250	0	0	0	0
Annual Cost Burden (Dollars)	87,282	0	0	87,282	0	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: $45,550

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

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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: 01/28/2021

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