Information Collection

Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....

IC 33658 under ICR 202406-3206-001 · OMB 3206-0174.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 20-116 Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....	Form and Instruction
RI 20-116 Information about the Cost to Elect Less Than the Maximu RI20-116_2024_10_DC.pdf	Form and Instruction
RI 20-117_DC Information about the Cost to Elect teh Maximum Survivor RI20-117_2024_10_DC.pdf	Form and Instruction
RI 20-63 Survivor Annuity Election for a Spouse RI20-063_2024_10.pdf	Form and Instruction
RI 20-117_ROC Information about the Cost to Elect the Maximum Survivor RI20-117_2024_12_ROC.pdf	Form and Instruction

Information Collection (IC) Details

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IC Title:

Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 831.631 5 CFR 842.613 5 CFR 842.614 5 CFR 842.612 5 CFR 842.611 5 CFR 842.615 5 CFR 831.632

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RI 20-116	Information about the Cost to Elect Less Than the Maximum Survivor Annuity	RI20-116_2024_10_DC.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 20-117_DC	Information about the Cost to Elect teh Maximum Survivor Annuity	RI20-117_2024_10_DC.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 20-63	Survivor Annuity Election for a Spouse	RI20-063_2024_10.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 20-117_ROC	Information about the Cost to Elect the Maximum Survivor Annuity	RI20-117_2024_12_ROC.pdf	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: OPM/Central-1

FR Citation: 75 FR 15013

Number of Respondents: 2,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,400	0	0	2,400
Annual IC Time Burden (Hours)	1,834	0	0	1,834
Annual IC Cost Burden (Dollars)	49,290	-39,420	39,420	49,290

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.