OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

RI 34-1, 34-17, Financial Resources Questionnaire, RI 34-3, RI 34-19, Notice of Amount Due Because of Annuity Overpayment and RI 34-20, Notice of Amount Due Because of FEHB Premium Underpayment.

ICR 202108-3206-005 · OMB 3206-0167 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form RI 34-1 Notices of Amount Due Because of Annuity Overpayment Form and Instruction Modified Repair queued
Citations.pdf Supplementary Document Uploaded 2021-08-31 Repair queued
RI 34-001_OMB_Supporting_Stmt_Final.docx Supporting Statement A Uploaded 2021-08-31 Repair queued
FACES 2017 FINAL 12212017signed.pdf Supplementary Document Uploaded 2021-08-30 Repair queued
RI34-001_30dayFRN_Published_2021_08_23.pdf Supplementary Document Uploaded 2021-08-30 Repair queued
RI34-001_60dayFRN_Published_2021_06_08.pdf Supplementary Document Uploaded 2021-08-30 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
33642 Notices of Amount Due Because of Annuity Overpayment Form and Instruction Modified
ICR Details
3206-0167 202108-3206-005
Received in OIRA 202003-3206-001
OPM RI 34-1, RI 34-3, RI 34-17, RI 34-19 and RI 34-20
RI 34-1, 34-17, Financial Resources Questionnaire, RI 34-3, RI 34-19, Notice of Amount Due Because of Annuity Overpayment and RI 34-20, Notice of Amount Due Because of FEHB Premium Underpayment.
Revision of a currently approved collection   No
Regular 08/31/2021
  Requested Previously Approved
36 Months From Approved 08/31/2021
2,361 2,361
2,361 2,361
63,452 0
Financial Resources Questionnaire (RI 34-1), Financial Resources Questionnaire - Federal Employees’ Group Life Insurance Premiums Underpaid (RI 34-17), and Financial Resources Questionnaire - Federal Employees Health Benefits Premiums Underpaid (RI 34-18), collects detailed financial information for use by OPM to determine whether to agree to a waiver, compromise, or adjustment of the collection of erroneous payments from the Civil Service Retirement and Disability Fund. Notice of Amount Due Because Of Annuity Overpayment (RI 34-3), Notice of Amount Due Because of FEGLI Premium Underpayment (RI 34-19), and Notice of Amount Due Because of FEHB Premium Underpayment (RI 34-20), informs the annuitant about the overpayment and collects information from the annuitant about how repayment will be made.
US Code: 31 USC Section 3716 Name of Law: Administrative Offset
  
None
Not associated with rulemaking
  86 FR 30503 06/08/2021
86 FR 47167 08/23/2021
No
  Total Request 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 2,361 2,361 0 0 0 0
Annual Time Burden (Hours) 2,361 2,361 0 0 0 0
Annual Cost Burden (Dollars) 63,452 0 0 1 63,451 0
No
No
$126,000
No
    Yes
    Yes
No
No
No
No
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.
08/31/2021