OMB Ss Sf 2823

OMB Supporting Statement

SF 2823 - Designation of Beneficiary (Federal Employees’ Group Life Insurance Program)

A. Justification

1. Title 5, United States Code, Section 8705, provides that employees and annuitants enrolled in the Federal Employees’ Group Life Insurance (FEGLI) Program may designate beneficiaries to receive monies payable under the FEGLI Program after the death of the enrollee. The law also provides that if the enrollee doesn’t designate a beneficiary, the monies will be paid according to the order of precedence listed in section 8705(a) of the law. Title 5, Code of Federal Regulations, section 870.802, gives further details on the requirements for a designation of beneficiary. Section 870.909 says that an assignee can also use the form to designate beneficiaries. (An assignee is someone who owns and controls the insured’s insurance.)

2. The Office of Personnel Management (OPM) uses Standard Form 2823 to collect the information that our contractor needs in order to pay the benefits as the enrollee or assignee wishes. Federal employees (or their assignees) file the form with their employing agency. Annuitants (or their assignees) file the form with OPM. OPM and agencies use the information on the form to identify where to send claim forms upon the insured’s death. OPM’s contractor uses the information on this form to pay life insurance benefits. We are requesting OMB clearance of this form solely due to its use by annuitants and assignees. The Public Burden Statement meets the requirements of 5 CFR 1320.8(b)(3).

3. The information collected is specific to the individual and can only be obtained from the respondents. Use of information technology is contingent on changes to the law. However, this form is available in a PDF format on our website for printing locally, and it meets GPEA requirements.

4. Designations are filed individually. Duplication is minimized. Up-to-date, similar information is not available.

5. This collection of information does not impact small businesses or other small entities.

6. If this information were not collected, OPM’s contractor could not comply with the provisions of the law and regulations. The contractor could not pay the life insurance benefits as the insured or assigned desired.

7. This information is collected at the convenience of the respondent. Less frequent collections would deny the insured or assignee a right given in the law and regulations.

8. A notice of proposed information collection was published in the Federal Register on September 21, 2016, as required by 5 CFR 1320, giving persons outside the agency an opportunity to comment on this form. No comments were received. Efforts to consult or engage individuals affected by collection of information on the form can be described as informal and occasional. Communications and consultation with affected parties are by email and telephone inquiries, as well as constructive feedback we receive from agency personnel during our bi-annual classroom training conferences. The inquiries take the form of questions relating to its proper use. Feedback on the use/design of the form is generally positive.

9. We will not pay respondents or give them gifts for responding.

10. The information collection is protected by the Privacy Act of 1974 and OPM regulations (5 CFR 831.106). The routine uses for disclosure appeared in the Federal Register for OPM/Central-1 (73 FR 15013, et seq., March 20, 2008). The form contains a caution to respondents that the information will be shared with the Office of Federal Employees’ Group Life Insurance (OFEGLI) and OPM and be placed in the insured’s personnel file.

11. This information collection does not include questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private.

12. We process approximately 48,000 designation forms from annuitants and approximately 1,000 designation forms from assignees each year. We estimate it takes 15 minutes to complete the form. These numbers remain consistent with the previous statement. The annual burden is 12,000 hours.

13. The total annual cost burden to respondents or record keepers is zero.

14. The estimated total annual cost to the Federal Government is $12,700. The cost includes employee salary hours devoted to the program, overhead, and forms costs.

15. There are no changes to the respondent burden.

16. The results of this information are not published.

17. We again seek approval to omit displaying the expiration date for OMB approval of the information collection. Based on experience, we know that if we display the expiration date, personnel offices become confused and think that completed forms on file prior to the current expiration date are invalid. As a consequence they request new forms when the current ones are still valid. This creates additional printings as an unintended consequence.

18. There are no exceptions to the certification statement.