OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202203-3206-001 · OMB 3206-0156 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form SF 2800 Application for Death Benefits Under the Civil Service Retirement System Form and Instruction Unchanged Repair queued
OMB_Justification_SF 2800A_2022_03_07.docx Justification for No Material/Nonsubstantive Change Uploaded 2022-03-07 Repair queued
SF2800_30dayFRN_Published_2021_06_30.pdf Supplementary Document Uploaded 2021-06-30 Repair queued
2021-02706.pdf Supplementary Document Uploaded 2021-06-30 Missing upstream
E8-5659.pdf Supplementary Document Uploaded 2018-04-04 Repair queued
FACES 2017 FINAL 12212017signed.pdf Supplementary Document Uploaded 2018-04-04 Repair queued
ARS PIA Final 12212017signed.pdf Supplementary Document Uploaded 2018-04-04 Missing upstream
SF2800_Citations.pdf Supplementary Document Uploaded 2018-04-04 Repair queued
SF2800_SF2800A_OMBSupportingStatement_2021_08_31.docx Supporting Statement A Uploaded 2021-08-31 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
33627 Application for Death Benefits Under the Civil Service Retirement System Form and Instruction Unchanged
ICR Details
3206-0156 202203-3206-001
Received in OIRA 202106-3206-012
OPM SF 2800/SF 2800A
Application for Death Benefits Under the Civil Service Retirement System/Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee
No material or nonsubstantive change to a currently approved collection   No
Regular 03/07/2022
  Requested Previously Approved
09/30/2024 09/30/2024
74,800 74,800
56,100 56,100
813,565 813,565
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.
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
  86 FR 8929 02/10/2021
86 FR 34797 06/30/2021
Yes
  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 74,800 74,800 0 0 0 0
Annual Time Burden (Hours) 56,100 56,100 0 0 0 0
Annual Cost Burden (Dollars) 813,565 813,565 0 0 0 0
No
No
$1,325,300
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.
03/07/2022