Representative Payee Survey

Forms and Documents

Document Name	Status
Form RI 38-115 Representative Payee Survey Form and Instruction	Modified
RI38-115_OMB_Supporting_Stmt_2021.docx Supporting Statement A	2021-06-28
E8-5659.pdf Supplementary Document	2021-06-28
RI38-115_Published60dayFRN_2021_04_02.pdf Supplementary Document	2021-06-28
RI38-115_30DayFRNPublished_2021_06_25.pdf Supplementary Document	2021-06-28

IC Document Collections

IC ID	Document Title	Status
33701	Representative Payee Survey Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0208	ICR Reference No: 202106-3206-004
Status: Received in OIRA	Previous ICR Reference No: 201804-3206-003
Agency/Subagency: OPM	Agency Tracking No: RI 38-115
Title: Representative Payee Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/29/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2021
Responses	11,000	11,000
Time Burden (Hours)	3,667	3,667
Cost Burden (Dollars)	98,450	0

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Abstract: 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.

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Authorizing Statute(s): 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.
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 17420	04/02/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 33786	06/25/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

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

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ICR Summary of Burden

	Total Request	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)	98,450	0	0	0	98,450	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $34,800

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 06/29/2021

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