RI 34-1, 34-17, Financial Resources Questionnaire, RI 34-3, RI 34-19, Notice of Amount Due Because of Annuity Overpayment and RI 34-20, Notice of Amount Due Because of FEHB Premium Underpayment.

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form RI 34-20 Notice of Amount Due Because of FEHB Premium Underpayment	Form and Instruction	Modified	Available
Form RI 34-20 Notice of Amount Due Because of FEHB Premium Underpayment	Form and Instruction	Modified	Available
Form RI 34-19 Notice of Amount Due Because of FEGLI Premium Underpayment	Form and Instruction	Modified	Available
Form RI 34-19 Notice of Amount Due Because of FEGLI Premium Underpayment	Form and Instruction	Modified	Available
Form RI 34-18 Financial Resources Questionnaire - Federal Employees’ Group Life Insurance Premiums Underpaid	Form and Instruction	Modified	Available
Form RI 34-18 Financial Resources Questionnaire - Federal Employees Health Benefits Premiums Underpaid	Form and Instruction	Modified	Available
Form RI 34-17 Financial Resources Questionnaire - Federal Employees’ Group Life Insurance Premiums Underpaid	Form and Instruction	Modified	Repair queued
Form RI 34-17 Financial Resources Questionnaire - Federal Employees’ Group Life Insurance Premiums Underpaid	Form and Instruction	Modified	Available
Form RI 34-3 Notice of Amount Due Because Of Annuity Overpayment	Form and Instruction	Modified	Available
Form RI 34-3 Notice of Amount Due Because Of Annuity Overpayment	Form and Instruction	Modified	Available
Form RI 34-1 Financial Resources Questionnaire	Form and Instruction	Modified	Available
Form RI 34-1 Financial Resources Questionnaire	Form and Instruction	Modified	Available
Form RI 34-1 Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Repair queued
Citations.pdf	Supplementary Document	Uploaded 2021-08-31	Repair queued
RI 34-001_OMB_Supporting_Stmt_Final.docx	Supporting Statement A	Uploaded 2021-08-31	Repair queued
FACES 2017 FINAL 12212017signed.pdf	Supplementary Document	Uploaded 2021-08-30	Repair queued
RI34-001_30dayFRN_Published_2021_08_23.pdf	Supplementary Document	Uploaded 2021-08-30	Available
RI34-001_60dayFRN_Published_2021_06_08.pdf	Supplementary Document	Uploaded 2021-08-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Notice of Amount Due Because of FEHB Premium Underpayment
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Notice of Amount Due Because of FEHB Premium Underpayment
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Notice of Amount Due Because of FEGLI Premium Underpayment
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Notice of Amount Due Because of FEGLI Premium Underpayment
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Financial Resources Questionnaire - Federal Employees’ Group Life Insurance Premiums Underpaid
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Financial Resources Questionnaire - Federal Employees Health Benefits Premiums Underpaid
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Financial Resources Questionnaire - Federal Employees’ Group Life Insurance Premiums Underpaid
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Financial Resources Questionnaire - Federal Employees’ Group Life Insurance Premiums Underpaid
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Notice of Amount Due Because Of Annuity Overpayment
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Notice of Amount Due Because Of Annuity Overpayment
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Financial Resources Questionnaire
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified	Financial Resources Questionnaire
33642	Notices of Amount Due Because of Annuity Overpayment	Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0167	ICR Reference No: 202108-3206-005
Status: Historical Active	Previous ICR Reference No: 202003-3206-001
Agency/Subagency: OPM	Agency Tracking No: RI 34-1, RI 34-3, RI 34-17, RI 34-19 and RI 34-20
Title: RI 34-1, 34-17, Financial Resources Questionnaire, RI 34-3, RI 34-19, Notice of Amount Due Because of Annuity Overpayment and RI 34-20, Notice of Amount Due Because of FEHB Premium Underpayment.
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: 10/05/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/31/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2024	36 Months From Approved	10/31/2021
Responses	2,361	0	2,361
Time Burden (Hours)	2,361	0	2,361
Cost Burden (Dollars)	63,452	0	0

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Abstract: Financial Resources Questionnaire (RI 34-1), Financial Resources Questionnaire - Federal Employees’ Group Life Insurance Premiums Underpaid (RI 34-17), and Financial Resources Questionnaire - Federal Employees Health Benefits Premiums Underpaid (RI 34-18), collects detailed financial information for use by OPM to determine whether to agree to a waiver, compromise, or adjustment of the collection of erroneous payments from the Civil Service Retirement and Disability Fund. Notice of Amount Due Because Of Annuity Overpayment (RI 34-3), Notice of Amount Due Because of FEGLI Premium Underpayment (RI 34-19), and Notice of Amount Due Because of FEHB Premium Underpayment (RI 34-20), informs the annuitant about the overpayment and collects information from the annuitant about how repayment will be made.

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Authorizing Statute(s): US Code: 31 USC Section 3716 Name of Law: Administrative Offset
  

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:
	86 FR 30503	06/08/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 47167	08/23/2021
Did the Agency receive public comments on this ICR? No

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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
Notices of Amount Due Because of Annuity Overpayment	RI 34-3, RI 34-3, RI 34-17, RI 34-18, RI 34-18, RI 34-19, RI 34-20, RI 34-20, RI 34-17, RI 34-19, RI 34-1, RI 34-1	Financial Resources Questionnaire ,   Financial Resources Questionnaire ,   Notice of Amount Due Because Of Annuity Overpayment ,   Notice of Amount Due Because Of Annuity Overpayment ,   Financial Resources Questionnaire - Federal Employees’ Group Life Insurance Premiums Underpaid ,   Financial Resources Questionnaire - Federal Employees’ Group Life Insurance Premiums Underpaid ,   Financial Resources Questionnaire - Federal Employees Health Benefits Premiums Underpaid ,   Financial Resources Questionnaire - Federal Employees’ Group Life Insurance Premiums Underpaid ,   Notice of Amount Due Because of FEGLI Premium Underpayment ,   Notice of Amount Due Because of FEGLI Premium Underpayment ,   Notice of Amount Due Because of FEHB Premium Underpayment ,   Notice of Amount Due Because of FEHB Premium Underpayment

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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	2,361	2,361	0	0	0	0
Annual Time Burden (Hours)	2,361	2,361	0	0	0	0
Annual Cost Burden (Dollars)	63,452	0	0	1	63,451	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: $126,000

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: 08/31/2021

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