Claim for Unpaid Compensation of Deceased Civilian Employee

ICR 201804-3206-004

OMB: 3206-0234

Federal Form Document

Forms and Documents
ICR Details
3206-0234 201804-3206-004
Active 201503-3206-002
OPM
Claim for Unpaid Compensation of Deceased Civilian Employee
Revision of a currently approved collection   Yes
Regular
Approved with change 06/12/2018
Retrieve Notice of Action (NOA) 04/27/2018
This collection is approved based upon the revised materaisl provided by the Agency.
  Inventory as of this Action Requested Previously Approved
06/30/2021 36 Months From Approved 06/30/2018
3,000 0 3,000
750 0 750
0 0 0

5 CFR 178.205(a) directs the agency in which a deceased employee was last employed to request, in the order of payment precedence outlined in 5 CFR 178.204, the appropriate person or persons to execute Standard Form 1153, "Claim for Unpaid Compensation of Deceased Civilian Employee." The information collected on this form is needed by the employing agencies and, in the event of a disputed claim, by OPM to help determine the claimant's and others' rights to the unpaid compensation of the deceased employee. 31 USC 3702 authorizes the Director of the Office of Personnel Management (OPM) to settle claims involving Federal civilian employees' compensation and leave. OMB promulgated regulations at 5 CFR 178 describing general procedures applicable to claims against the United States that may be settled by the OPM Director.

US Code: 31 USC 3702 Name of Law: null
  
None

Not associated with rulemaking

  83 FR 3034 01/22/2018
83 FR 15423 04/10/2018
No

  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 3,000 3,000 0 3,000 -3,000 0
Annual Time Burden (Hours) 750 750 0 750 -750 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Previous version removed but is still showing above.

$30,000
No
    No
    Yes
No
No
No
Uncollected
Sherri McCall 202 606-7126 sherri.mccall@opm.gov

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

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.
04/27/2018


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