Representative Payee Application/Information Necessary for a Competency Determination

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form RI 20-7 Representative Payee Application (2024; Mark-Up)	Form and Instruction	Modified	Available
Form RI 30-3 Information Necessary for a Competency Determination (2024, Mark Up)	Form and Instruction	Modified	Available
Form RI 30-3 Representative Payee Application/Information Necessary for a Competency Determination	Form and Instruction	Modified	Repair queued
RI20-007_RI30-003_OMBSupportingStmt_2024_04_30_Final.docx	Supporting Statement A	Uploaded 2024-04-30	Repair queued
2023-04940.pdf	Supplementary Document	Uploaded 2024-04-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33606	Representative Payee Application/Information Necessary for a Competency Determination	Form and Instruction	Modified	Representative Payee Application (2024; Mark-Up)
33606	Representative Payee Application/Information Necessary for a Competency Determination	Form and Instruction	Modified	Information Necessary for a Competency Determination (2024, Mark Up)
33606	Representative Payee Application/Information Necessary for a Competency Determination	Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0140	ICR Reference No: 202404-3206-008
Status: Active	Previous ICR Reference No: 202101-3206-005
Agency/Subagency: OPM	Agency Tracking No: RI 20-7/RI 30-3
Title: Representative Payee Application/Information Necessary for a Competency Determination
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: 06/18/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/30/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2027	36 Months From Approved	06/30/2024
Responses	12,480	0	12,480
Time Burden (Hours)	6,490	0	6,490
Cost Burden (Dollars)	174,418	0	174,418

---

Abstract: RI 20-7, Representative Payee Application, is used by the Civil Service Retirement System (CSRS) and the Federal Employees Retirement System (FERS) to collect information from persons applying to be fiduciaries for minor children, annuitants, or survivor annuitants who appear to be incapable of handling their own funds. RI 30-3, Information Necessary for a Competency Determination, collects medical information regarding the annuitant's competency for OPM's use in evaluating the annuitant's condition.

---

Authorizing Statute(s): US Code: 5 USC Chapter 83 Section 8345 Name of Law: CSRS, Payment of Benefits; commencement, termination, and waiver of annuity
   US Code: 5 USC Chapter 84 Section 8466 Name of Law: FERS, Application for Benefits
   US Code: 5 USC Chapter 83 Section 8344 Name of Law: CSRS, Annuities & Pay on Reemployment
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
3206-AO08	Final or interim final rulemaking	86 FR 57011	10/14/2021

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 59434	10/27/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 15105	03/10/2023
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Representative Payee Application/Information Necessary for a Competency Determination	RI 30-3, RI 20-7	Information Necessary for a Competency Determination (2024, Mark Up) ,   Representative Payee Application (2024; Mark-Up)

---

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	12,480	12,480	0	0	0	0
Annual Time Burden (Hours)	6,490	6,490	0	0	0	0
Annual Cost Burden (Dollars)	174,418	174,418	0	0	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:

---

Annual Cost to Federal Government: $198,850

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: 04/30/2024

---