View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 3206-0230	ICR Reference No: 202203-3206-007
Status: Historical Active	Previous ICR Reference No: 202107-3206-001
Agency/Subagency: OPM	Agency Tracking No: SF 2817
Title: Life Insurance Election
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/10/2022
	Date Received in OIRA: 03/07/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2024	09/30/2024	09/30/2024
Responses	150	0	150
Time Burden (Hours)	38	0	38
Cost Burden (Dollars)	1,009	0	1,009

Annual Cost to Federal Government: $11,689

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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