View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 3206-0218	ICR Reference No: 202010-3206-011
Status: Historical Active	Previous ICR Reference No: 201703-3206-018
Agency/Subagency: OPM	Agency Tracking No: RI 94-7
Title: RI 94-7, Death Benefit Payment Rollover Election Form
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: 12/08/2020
	Date Received in OIRA: 10/16/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2023	36 Months From Approved	12/31/2020
Responses	3,444	0	3,444
Time Burden (Hours)	3,444	0	3,444
Cost Burden (Dollars)	0	0	0

Annual Cost to Federal Government: $155,021

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

Agency Contact: Charles Conyers 202 606-0125 charles.conyers@opm.gov

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