RI 38-117, Rollover Election, RI 37-118, Rollover Information, and RI 37-22, Special Tax Notice Regarding Rollovers

Forms and Documents

Document Name	Status
Form RI 38-117 RI 38-117, Rollover Election Form and Instruction	Modified
60-day FRN.pdf Supplementary Document	2012-11-05
30-DAY FRN.pdf Supplementary Document	2012-11-05
RI 38-117 SS.doc Supporting Statement A	2012-11-05

IC Document Collections

IC ID	Document Title	Status
33708	RI 38-117, Rollover Election Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0212	ICR Reference No: 201211-3206-003
Status: Historical Active	Previous ICR Reference No: 201008-3206-001
Agency/Subagency: OPM	Agency Tracking No:
Title: RI 38-117, Rollover Election, RI 37-118, Rollover Information, and RI 37-22, Special Tax Notice Regarding Rollovers
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/13/2012
	Date Received in OIRA: 11/06/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2015	36 Months From Approved	01/31/2013
Responses	1,500	0	1,500
Time Burden (Hours)	1,000	0	1,000
Cost Burden (Dollars)	0	0	0

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Abstract: RI 38-117, Rollover Election, is used to collect information from each payee affected by a change in the tax code so that OPM can make payment in accordance with the wishes of the payee. RI 38-118, Rollover Information, explains the election. RI 37-22, Special Tax Notice Regarding Rollovers, provides more detailed information.

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Authorizing Statute(s): PL: Pub.L. 107 - 16 643 Name of Law: Rollovers of after-tax contributions
   PL: Pub.L. 107 - 147 411 Name of Law: Amendments related to Economic Growth and Tax Relief Reconciliation Act of 2001
   US Code: 5 USC 8432(j)(2) Name of Law: Lump-sum benefits; designation of beneficiary; order of precedence
   PL: Pub.L. 107 - 16 641 Name of Law: Rollovers allowed among various types of plans
   US Code: 26 USC 402(f) and 402(c)(2) Name of Law: Taxability of beneficiary of employees' trust
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 33007	06/04/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 66187	11/02/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
RI 38-117, Rollover Election	RI 38-117, RI 38-118, RI 37-22	Rollover Election ,   Rollover Information ,   Special Tax Notice Regarding Rollovers

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ICR Summary of Burden

	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	1,500	1,500	0	0	0	0
Annual Time Burden (Hours)	1,000	1,000	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $8,500

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/06/2012

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