Application for Death Benefits Under the Civil Service Retirement System/Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee

ICR 202106-3206-012

OMB: 3206-0156

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2021-06-30
Supplementary Document
2021-06-30
Supplementary Document
2018-04-04
Supplementary Document
2018-04-04
Supplementary Document
2018-04-04
Supplementary Document
2018-04-04
Supporting Statement A
2021-06-30
IC Document Collections
ICR Details
3206-0156 202106-3206-012
Received in OIRA 201804-3206-001
OPM SF 2800/SF 2800A
Application for Death Benefits Under the Civil Service Retirement System/Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee
Revision of a currently approved collection   No
Regular 06/30/2021
  Requested Previously Approved
36 Months From Approved 06/30/2021
74,800 74,800
56,100 56,100
813,565 0

SF 2800 is needed to collect information so that OPM can pay death benefits to the survivors of Federal employees and annuitants. SF 2800A is needed for deaths in service so that survivors can make the needed election regarding military service. Every applicant who uses SF 2800 should read SF 2800-1, Applying for Death Benefits under CSRS. This brief booklet provides the general information applicants need to understand what they are applying for.

US Code: 5 USC Chapter 83, Section 8342 Name of Law: Lump-sum benefits; designation of beneficiary; order
   US Code: 5 USC Chapter 83, Section 8341 Name of Law: Survivor Annuities
  
None

Not associated with rulemaking

  86 FR 8929 02/10/2021
86 FR 34797 06/30/2021
Yes

  Total Request 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 74,800 74,800 0 0 0 0
Annual Time Burden (Hours) 56,100 56,100 0 0 0 0
Annual Cost Burden (Dollars) 813,565 0 0 813,565 0 0
No
No

$1,325,300
No
    Yes
    Yes
No
No
No
No
Charles Conyers 202 606-0125 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/30/2021


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