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Federal forms, ICRs, and supporting documents

Information Collection Request

Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits

ICR 201701-3206-005 · OMB 3206-0233 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form RI 25-51 Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits Form and Instruction Unchanged Available
RI25-051_30dayFRNPublished_2017_05_05.pdf Supplementary Document Uploaded 2017-05-12 Available
RI25-051_OMB_Support_Stmt_2017_04_11.doc Supporting Statement A Uploaded 2017-05-12 Available
RI25-051_60DayFRN_Published_2016_07_21.pdf Supplementary Document Uploaded 2017-01-10 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
33746 Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits Form and Instruction Unchanged
ICR Details
3206-0233 201701-3206-005
Historical Active 201402-3206-002
OPM RI 25-51
Civil Service Retirement System Survivor Annuitant Express Pay Application for Death Benefits
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 10/02/2017
Retrieve Notice of Action (NOA) 05/15/2017
OPM should report this collection in the Information Collection Budget. OPM is asked to review the privacy act statement on the form and to provide the most recent PIA and SORN for the collection when it is next submitted to OMB for renewal.
  Inventory as of this Action Requested Previously Approved
10/31/2020 6 Months From Approved
34,800 0 0
17,400 0 0
0 0 0
RI 25-51 will be used by the Civil Service Retirement System solely to pay benefits to the widow(er) of an annuitant. This application is intended for use in immediately authorizing payments to an annuitant's widow or widower, based on the report of death, when our records show the decedent elected to provide benefits for the applicant.
US Code: 5 USC 8341 Name of Law: Survivor Annuitants
   US Code: 5 USC 8342 Name of Law: Lump-Sum Benefits; Designation of Beneficiaries; Order of Precedence
  
None
Not associated with rulemaking
  81 FR 47444 07/21/2016
82 FR 21276 05/05/2017
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 34,800 0 0 0 0 34,800
Annual Time Burden (Hours) 17,400 0 0 0 0 17,400
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$531,200
No
    Yes
    Yes
No
No
No
Uncollected
Charles Conyers 202 606-0125 [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.
05/15/2017