Information Collection

RI 76-10 Assignment, Federal Employees' Group Life Insurance (FEGLI) Program

IC 218450 under ICR 201510-3206-001 · OMB 3206-0270.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0270 can be found here:

Documents and Forms

Document Name Document Type
RI 76-10 Jun 2015.pdf OMB Supporting Statement IC Document
60-day FRN.pdf 60-Day FRN IC Document
RI76-010_30DayFRN_Published_2015_02_19.pdf 30-Day FRN IC Document
RI 76-10 Jun 2015.pdf Form RI 76-10 Assignment, Ferderal Employees' Group Life Insurance Program IC Document
RI 76-10 Supporting Statement.doc OMB Justification Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	RI 76-10 Assignment, Federal Employees' Group Life Insurance (FEGLI) Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 8706

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records
Title: OPM/Central-1	FR Citation: 73 FR 15013

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Supporting Statement	RI 76-10 Jun 2015.pdf	10/02/2015
60-Day FRN	60-day FRN.pdf	10/02/2015
30-Day FRN	RI76-010_30DayFRN_Published_2015_02_19.pdf	10/02/2015
Form RI 76-10 Assignment, Ferderal Employees' Group Life Insurance Program	RI 76-10 Jun 2015.pdf	10/02/2015
OMB Justification Statement	RI 76-10 Supporting Statement.doc	10/02/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.