View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
3206-0212
ICR Reference No:
201904-3206-001
Status:
Historical Active
Previous ICR Reference No:
201510-3206-003
Agency/Subagency:
OPM
Agency Tracking No:
RI 38-117, RI 37-118 and RI 37-22
Title:
RI 38-117, Rollover Election, RI 37-118, Rollover Information, and RI 37-22, Special Tax Notice Regarding Rollovers
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:
07/08/2019
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/30/2019
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2022
36 Months From Approved
08/31/2019
Responses
1,500
0
1,500
Time Burden (Hours)
1,000
0
1,000
Cost Burden (Dollars)
60,249
0
0
Abstract:
RI 38-117, Rollover Election, is used to collect information from each payee affected by a change in the tax code so that OPM can make payment in accordance with the wishes of the payee. RI 38-118, Rollover Information, explains the election. RI 37-22, Special Tax Notice Regarding Rollovers, provides more detailed information. Privacy Act Statements have been added to RI 38--117 and RI 37-22.The Privacy Act Statement for RI 38--117 has been revised due to a general systematic review by our Chief Privacy Officer.
Authorizing Statute(s):
US Code:
5 USC 8432(j)(2)
Name of Law: Lump-sum benefits; designation of beneficiary; order of precedence
PL:
Pub.L. 107 - 147 411
Name of Law: Amendments related to Economic Growth and Tax Relief Reconciliation Act of 2001
PL:
Pub.L. 107 - 16 643
Name of Law: Rollovers of after-tax contributions
PL:
Pub.L. 107 - 16 641
Name of Law: Rollovers allowed among various types of plans
US Code:
26 USC 402(f) and 402(c)(2)
Name of Law: Taxability of beneficiary of employees' trust
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
83 FR 62630
12/04/2018
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 8917
03/12/2019
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
RI 38-117, Rollover Election
RI 38-117, RI 38-118, RI 38-117, RI 38-118, RI 37-22, RI N37-22
Rollover Election
,
Rollover Information
,
Rollover Information
,
Special Tax Notice Regarding Rollovers
,
Special Tax Notice Regarding Rollovers
ICR Summary 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
1,500
1,500
0
0
0
0
Annual Time Burden (Hours)
1,000
1,000
0
0
0
0
Annual Cost Burden (Dollars)
60,249
0
0
0
60,249
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:
$8,500
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?
Uncollected
Agency Contact:
Charles Conyers 202 606-0125 charles.conyers@opm.gov
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:
05/30/2019
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