Representative Payee Survey

ICR 201804-3206-003

OMB: 3206-0208

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2018-05-31
Supplementary Document
2018-04-13
Supplementary Document
2018-04-13
Supplementary Document
2018-04-13
Supplementary Document
2018-04-13
IC Document Collections
IC ID
Document
Title
Status
33701 Modified
ICR Details
3206-0208 201804-3206-003
Active 201706-3206-001
OPM RI 38-115
Representative Payee Survey
Revision of a currently approved collection   No
Regular
Approved with change 06/04/2018
Retrieve Notice of Action (NOA) 04/24/2018
This collection is approved based on the revised materials provided by the Agency. Before this collection is next submitted to OMB for review, OPM should consider if it should be a common form as it appears to be an nformation collection in use government-wide for the same purpose.
  Inventory as of this Action Requested Previously Approved
06/30/2021 36 Months From Approved 06/30/2018
11,000 0 11,000
3,667 0 3,667
0 0 0

RI 38-115 is designed to collect information about how the benefits paid to a representative payee have been used or conserved for the benefit of the incompetent annuitant. There are editorial changes to the Privacy Act Statement (PAS).

US Code: 5 USC Chapter 83, Section 8347(a) Name of Law: CSRS, Administration; regulations
   US Code: 5 USC Chapter 83, Section 8345(e) Name of Law: CSRS, Payment of benefits; commencement, termination, and waiver of annuity
   US Code: 5 USC Chapter 84, Section 8466(c) Name of Law: FERS, Application for Benefits
   US Code: 5 USC Chapter 84, Section 8461(g) Name of Law: FERS, Authority of the Office of Personnel Management.
  
None

Not associated with rulemaking

  83 FR 3035 01/22/2018
83 FR 15879 04/12/2018
No

1
IC Title Form No. Form Name
Representative Payee Survey RI 38-115, RI 38-115 Representative Payee Survey ,   Representative Payee Survey

  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 11,000 11,000 0 0 0 0
Annual Time Burden (Hours) 3,667 3,667 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$34,800
No
    Yes
    Yes
No
No
No
Uncollected
Charles Conyers 202 606-0125 charles.conyers@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.
04/24/2018


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