Ri 20-123_ Ss_ 2019

3206-0254

OMB SUPPORTING STATEMENT

RI 20-123 – Request for Case Review for Enhanced Disability Annuity Benefit

1. Justification

1. Title 5, U. S. Code, Chapter 83, Sections 8337 and 8339, and Chapter 84, Section 8452, provide for disability retirement benefits for individuals who performed service as law enforcement officers, firefighters, nuclear materials carriers, Customs and Border Patrol officers, members of the Capitol and the Supreme Court police, Congressional employees, and air traffic controllers. A series of court decisions affect the computation of benefits. Because these court orders were handed down long after some of the affected individuals retired and/or died and the individuals are not identified in the Office of Personnel Management (OPM) computer systems, it is necessary for the affected individuals to self-identify. Form RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit, is used by the affected individuals and their survivors to request that their benefit computations be reviewed.

2. RI 20-123 is available to annuitants and survivor annuitants only on the OPM website.
   It is used by retirees separated for disability and the survivors of retirees separated for disability to request that Retirement Operations review the computations of disability annuities to include the formulae provided in law for individuals who performed service
   as law enforcement officers, firefighters, nuclear materials carriers, air traffic controllers, Congressional employees, and Capitol and Supreme Court police. When responses are received, action is taken to review the annuity computation and, if the respondent is entitled to an increased benefit, the benefit is authorized. A Privacy Act Statement has been added due to a systematic review. There were editorial changes to the Public Burden Statement to meet the requirement of 5 CFR 1320.8(b)(3).

3. Use of improved information technology to reduce the burden is not practical. The information collected can only be obtained from the respondents. However, this form will be available in a PDF fillable format on our website and meets our GPEA requirements.

4. Every effort is made to identify and avoid duplication. The information is collected individually and respondents with no earnings are asked not to respond. There is no other way to obtain this information.

5. This information collection request has no impact on small businesses and organizations.

6. If this information is not collected, the pay of eligible annuitants and survivor annuitants would not receive the computed pay difference provided in law for individuals who performed the aforementioned service.

7. There are no special circumstances involved in the collection of this information.

8. On February 4, 2019, a 60 Day Federal Register Notice was published at 84 FR 1524 requesting comment. No comments were received.
   
   

9. No payment or gift is provided to respondents.

10. This information collection is protected by the Privacy Act of 1974 and OPM regulations (5 CFR 831.106). The routine uses of disclosure appear in the Federal Register for OPM/Central-1 (73 FR 15013, et seq., March 20, 2008, effective April 21, 2008).

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 estimate 100 forms RI 20-123 are processed annually. The form takes approximately 5 minutes to complete, the annual burden is 8 hours.

Form Name	Form Number	No. of Respondents	No. of Responses per Respondent	Average Burden per Response (in hours)	Total Annual Burden (in hours)	Average Hourly Wage Rate	Total Annual Respondent Cost
Request for Case Review for Enhanced Disability Annuity Benefit	RI 20-123	100	1	.08333	8	$21.50	$225.00

The cost to the respondent is $225.00.

13. There is no change in the respondent burden.

14. The annualized cost to the Federal government is $5,550. This cost is derived from employee salaries, staff hours required to process the forms and the cost of printing, storing and shipping forms.

15. N/A

16. The results of this collection are not published.

17. The Retirement Services program office is the lone processor of the data collected on these ICRs from approximately 2.8 million customers. The substance of each information collection does not substantively change at each OMB renewal cycle, but according to changes in law and regulation. These forms are printed and published (internet, intranet and on-board systems) through various agencies for distribution to and implementation by Government customers. Pursuant to title 5 CFR 1320.8(b)(1), it would not be appropriate to display the OMB clearance expiration date where the form will not be revised for the foreseeable future (e.g., because it is used to collect applicant, annuitant, or beneficiary information required by long-standing statutory provisions), where use of the paper form is prevalent, and where, accordingly, it will be expensive and burdensome to restock the paper forms inventory with a new version. Last year, under current practice, Retirement Services printed approximately 2 million documents subject to OMB clearance at a cost of approximately $85,000. Our costs would rise substantially if additional revision cycles are added. Lastly, by adding the OMB clearance expiration date to the existing format, the end users of OPM’s ICRs may erroneously assume that the expiration date affects the validity of the information collection when it is the OMB clearance expiration date and not reflective of the substance. This may lead to additional submissions by customers, possible litigation and increasing pressures on our Operations workloads. Therefore, we seek approval to not display the OMB clearance expiration date on the forms and to communicate version changes to the public via the revision date. The results of this collection are not published.

18. There are no exceptions to the certification statement.