DISTRIBUTION OF FEHB/FEGLI IMPLEMENTATION QUESTIONNAIRE TO TRIBES AND URBAN INDIAN ORGANIZATIONS

ICR 201010-3206-002

OMB: 3206-0251

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Supporting Statement A
2010-10-01
ICR Details
3206-0251 201010-3206-002
Historical Active
OPM
DISTRIBUTION OF FEHB/FEGLI IMPLEMENTATION QUESTIONNAIRE TO TRIBES AND URBAN INDIAN ORGANIZATIONS
New collection (Request for a new OMB Control Number)   No
Emergency 10/01/2010
Approved with change 10/03/2010
Retrieve Notice of Action (NOA) 10/01/2010
This collection is approved to permit the agencies to collect preliminary, anecdotal data. OMB advises that the results of this collection should not be relied upon to develop statistical estimates or to justify significant policy decisions. OMB welcomes the opportunity to work with the agencies to develop future collections that comport with OMB’s Standards and Guidelines for Statistical Surveys to ensure that the agencies obtain reliable statistical information that is representative of the population.
  Inventory as of this Action Requested Previously Approved
04/30/2011 6 Months From Approved
600 0 0
200 0 0
0 0 0

This questionnaire is required to gather information needed to properly scope and implement the provision in S. 1790, the Indian Health Care Improvement Reauthorization and Extension Act of 2009, allowing for eligible Tribes and urban Indian organizations to purchase FEHB and FEGLI coverage. This questionnaire also serves to initiate Tribal consultation in accordance with Executive Order 13175.
OPM requests an emergency review of this FEHB/ FEGLI Implementation Questionnaire for Tribes and Tribal Organizations so critical information regarding the eligible population can be gathered in order to proceed with implementation by January 2011. This is in accordance with the statutorily mandated provision providing eligible tribes with the opportunity to purchase FEHB and FEGLI coverage. In absence of this collection, there is insufficient information available to adequately determine the scope and cost of implementation. This questionnaire serves to gather the requisite information, allowing OPM to proceed with the implementation process. An emergency review of the above mentioned questionnaire will ensure this information can be gathered expeditiously, so this provision can be properly scoped, implemented, and operational as quickly as possible.

EO: EO 13175 Name/Subject of EO: Consultation and Coordination with Indian Tribal Governments
  
None

Not associated with rulemaking

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 600 0 0 600 0 0
Annual Time Burden (Hours) 200 0 0 200 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new collection for OPM in support of E.O. 13175.

$0
No
No
Yes
Uncollected
No
Uncollected
Miles Windsor 202 606-8358 miles.windsor@opm.gov

  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.
10/01/2010


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