OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

SF 2800, Application for Death Benefits Under the Civil Service Retirement System/SF 2800A, Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee

ICR 201502-3206-004 · OMB 3206-0156 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form SF 2800 Application for Death Benefits Under the Civil Service Retirement System Form and Instruction Unchanged Available
SF 2800 Supporting Statement.doc Supplementary Document Uploaded 2015-02-05 Available
2015-01940 30-DAY FRN 2 2 2015.pdf Supplementary Document Uploaded 2015-02-05 Available
60-Day FRN.pdf Supplementary Document Uploaded 2015-02-05 Available
SF 2800-1 (07-11).pdf Supplementary Document Uploaded 2012-01-04 Available
SF 2800 Supporting Statement.doc Supporting Statement A Uploaded 2015-04-23 Available
IC Document Collections
IC IDCollectionTypeStatusForm
33627 Application for Death Benefits Under the Civil Service Retirement System Form and Instruction Unchanged
ICR Details
3206-0156 201502-3206-004
Historical Active 201201-3206-006
OPM
SF 2800, Application for Death Benefits Under the Civil Service Retirement System/SF 2800A, Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee
Revision of a currently approved collection   No
Regular
Approved with change 04/27/2015
Retrieve Notice of Action (NOA) 02/09/2015
This collection is approved based on the revised materials provided by the Agency.
  Inventory as of this Action Requested Previously Approved
04/30/2018 36 Months From Approved 04/30/2015
74,800 0 74,800
56,100 0 56,100
0 0 0
SF 2800 is needed to collect information so that OPM can pay death benefits to the survivors of Federal employees and annuitants. SF 2800A is needed for deaths in service so that survivors can make the needed election regarding military service. Every applicant who uses SF 2800 should read SF 2800-1, Applying for Death Benefits under CSRS. This brief booklet provides the general information applicants need to understand what they are applying for. SF 2800 was approved by OMB as a no material or non substantial change on 09/30/2011. SF 2800A was revised to bring the form up-to-date.
US Code: 5 USC Chapter 83, Section 8341 Name of Law: Survivor Annuities
   US Code: 5 USC Chapter 83, Section 8342 Name of Law: Lump-sum benefits; designation of beneficiary; order
  
None
Not associated with rulemaking
  79 FR 41603 07/16/2014
80 FR 5586 02/02/2015
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 74,800 74,800 0 0 0 0
Annual Time Burden (Hours) 56,100 56,100 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$1,325,300
No
No
No
No
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.
02/09/2015