SF 2823, Designation of Beneficiary - Federal Employees' Group Life Insurance Program (FEGLI)

ICR 202010-3206-015

OMB: 3206-0136

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2020-10-22
Supplementary Document
2020-10-22
Supplementary Document
2020-10-22
Supplementary Document
2020-10-22
Supporting Statement A
2020-10-22
ICR Details
3206-0136 202010-3206-015
Active 201703-3206-010
OPM SF 2823
SF 2823, Designation of Beneficiary - Federal Employees' Group Life Insurance Program (FEGLI)
Revision of a currently approved collection   No
Regular
Approved without change 12/22/2020
Retrieve Notice of Action (NOA) 11/02/2020
  Inventory as of this Action Requested Previously Approved
12/31/2023 36 Months From Approved 12/31/2020
48,000 0 48,000
12,000 0 12,000
0 0 0

Standard Form 2823 is used by any Federal employee or retiree covered by the Federal Employees' Group Life Insurance (FEGLI) Program, or an assignee who owns an insured's coverage, to instruct the Office of Federal Employees' Group Life Insurance how to distribute the proceeds of the FEGLI coverage when the statutory order of precedence does not meet his or her needs. The Privacy Act Statement has been revised due to a systematic review by our Chief Privacy Officer.

US Code: 5 USC Section 8705, Subpart G Name of Law: Insurance and Annuities
  
None

Not associated with rulemaking

  85 FR 13678 03/09/2020
85 FR 63301 10/07/2020
Yes

  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 48,000 48,000 0 0 0 0
Annual Time Burden (Hours) 12,000 12,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 -2,685 2,685 0
No
No

$12,700
No
    Yes
    Yes
No
No
No
No
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.
11/02/2020


© 2024 OMB.report | Privacy Policy