Flags Request Form

Forms and Documents

Document Name	Status
Form OPM 1825 OPM 1825 Form and Instruction	Unchanged
Supporting Statement for OPM1825.DOC.doc Supporting Statement A	2014-09-10
2014-05277 30 day notice.pdf Supplementary Document	2014-03-12
2013-14087 60 day notice.pdf Supplementary Document	2014-03-12

IC Document Collections

IC ID	Document Title	Status
210682	OPM 1825 Form and Instruction	Unchanged

ICR Details

OMB Control No: 3206-0264	ICR Reference No: 201409-3206-001
Status: Historical Active	Previous ICR Reference No: 201403-3206-001
Agency/Subagency: OPM	Agency Tracking No:
Title: Flags Request Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/24/2014
	Date Received in OIRA: 09/10/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	36 Months From Approved
Responses	10	0	0
Time Burden (Hours)	2	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Civilian Service Recognition Act of 2011 (Public Law 112-73) authorizes an agency to furnish a United States flag on behalf of an employee who dies of injuries incurred in connection with his/her employment under specified circumstances. OPM Form OPM 1825, Application for U.S. Flag Recognition Benefit for Deceased Federal Civilian Employees, may be used to determine deceased Federal employee and beneficiary (e.g., family member of a deceased employee) eligibility for issuance of a U.S. flag. The form may be used by any Federal entity and use of the form is at agency discretion.

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Authorizing Statute(s): PL: Pub.L. 112 - 73 2 Name of Law: Civilian Service Recognition Act of 2011
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
3206-AM58	Final or interim final rulemaking	79 FR 53601	09/10/2014

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 36314	06/17/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 13687	03/11/2014
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
OPM 1825	OPM 1825	APPLICATION FOR U.S. FLAG RECOGNITION BENEFIT FOR DECEASED FEDERAL CIVILIAN EMPLOYEES

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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	10	0	0	10	0	0
Annual Time Burden (Hours)	2	0	0	2	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: Burden increase is due to creation of the flags for fallen Federal employees regulation.

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Annual Cost to Federal Government: $0

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:  Yes

Description/Changes for Common Form Usage:  Agencies may change address and agency names as permitted by common forms.

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 09/10/2014

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