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Federal forms, ICRs, and supporting documents

Information Collection Request

DISTRIBUTION OF FEHB/FEGLI IMPLEMENTATION QUESTIONNAIRES TO TRIBES AND URBAN INDIAN ORGANIZATIONS

ICR 201010-3206-004 · OMB 3206-0251 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0 FEHB/ FEGLI Implementation Questionnaire for Urban Indian Organizations Form and Instruction New Available
Form 0 FEHB/ FEGLI Implementation Questionnaire for Tribes and Tribal Organizations Form and Instruction Modified Repair queued
combined Tribal SUPPORTING STATEMENT-2[1].doc Supporting Statement A Uploaded 2010-10-05 Available
IC Document Collections
IC IDCollectionTypeStatusForm
194787 FEHB/ FEGLI Implementation Questionnaire for Urban Indian Organizations Form and Instruction New
194771 FEHB/ FEGLI Implementation Questionnaire for Tribes and Tribal Organizations Form and Instruction Modified
ICR Details
3206-0251 201010-3206-004
Historical Active 201010-3206-002
OPM
DISTRIBUTION OF FEHB/FEGLI IMPLEMENTATION QUESTIONNAIRES TO TRIBES AND URBAN INDIAN ORGANIZATIONS
Revision of a currently approved collection   No
Emergency 10/05/2010
Approved without change 10/05/2010
Retrieve Notice of Action (NOA) 10/05/2010
This collection is approved to permit the agencies to collect preliminary, anecdotal data. OMB advises that the results of this collection should not be relied upon to develop statistical estimates or to justify significant policy decisions. OMB welcomes the opportunity to work with the agencies to develop future collections that comport with OMB’s Standards and Guidelines for Statistical Surveys to ensure that the agencies obtain reliable statistical information that is representative of the population.
  Inventory as of this Action Requested Previously Approved
04/30/2011 6 Months From Approved 04/30/2011
629 0 600
210 0 200
0 0 0
These questionnaires are required to gather information needed to properly scope and implement the provision in S. 1790, the Indian Health Care Improvement Reauthorization and Extension Act of 2009, allowing for eligible Tribes and urban Indian organizations to purchase FEHB and FEGLI coverage. These questionnaires also serves to initiate Tribal consultation in accordance with Executive Order 13175. There is a questionnaire for Tribal Leaders and a questionnaire for Urban Indian Organizations.
OPM requests an emergency review of these FEHB/ FEGLI Implementation Questionnaires for Tribes and Tribal Organizations so critical information regarding the eligible population can be gathered in order to proceed with implementation by January 2011. This is in accordance with the statutorily mandated provision providing eligible tribes with the opportunity to purchase FEHB and FEGLI coverage. In absence of this collection, there is insufficient information available to adequately determine the scope and cost of implementation. These questionnaires serve to gather the requisite information, allowing OPM to proceed with the implementation process. An emergency review of the above mentioned questionnaires will ensure this information can be gathered expeditiously, so this provision can be properly scoped, implemented, and operational as quickly as possible.
EO: EO 13175 Name/Subject of EO: Consultation and Coordination with Indian Tribal Governments
  
None
Not associated with rulemaking
No
  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 629 600 0 29 0 0
Annual Time Burden (Hours) 210 200 0 10 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
Originally the numbers for the Urban Indian Organizations were counted within the Tribal Leaders. This has been corrected and the urban organization IC has been added to reflect the appropriate burden for each IC.
$0
No
No
Yes
Uncollected
No
Uncollected
Miles Windsor 202 606-8358 [email protected]
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/05/2010