RI 94-7, Death Benefit Payment Rollover Election Form

ICR 201401-3206-002

OMB: 3206-0218

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2014-01-27
Supplementary Document
2014-01-27
Supporting Statement A
2014-01-27
IC Document Collections
ICR Details
3206-0218 201401-3206-002
Historical Active 201011-3206-004
OPM
RI 94-7, Death Benefit Payment Rollover Election Form
Extension without change of a currently approved collection   No
Regular
Approved without change 03/25/2014
Retrieve Notice of Action (NOA) 02/18/2014
  Inventory as of this Action Requested Previously Approved
03/31/2017 36 Months From Approved 04/30/2014
3,444 0 3,444
3,444 0 3,444
0 0 0

Provides FERS surviving spouses and surviving former spouses with the means to elect payment of FERS rollover-eligible benefits directly or to an Individual Retirement Arrangement (IRA), eligible employer plan or Thrift Savings Plan (TSP) account.

PL: Pub.L. 102 - 318 106 Name of Law: Unemployment Compensation Amendment of 1992
  
None

Not associated with rulemaking

  78 FR 55124 09/09/2013
79 FR 3876 01/23/2014
No

1
IC Title Form No. Form Name
RI 94-7, Death Benefit Payment Rollover Election Form RI 94-7 Death Benefit Payment Rollover Election

  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 3,444 3,444 0 0 0 0
Annual Time Burden (Hours) 3,444 3,444 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$155,021
No
No
No
No
No
Uncollected
Steve Pierce 202 606-2560 Steven.Pierce@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.
02/18/2014


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