SF1153_OMB__Stmt A 3206-0234

OMB SUPPORTING STATEMENT
SF1153 – Claim for Unpaid Compensation of Deceased Civilian Employee
A. Justification
1. Explain the circumstances that make the collection of information necessary. Identify
any legal or administrative requirements that necessitate the collection. Attach a copy of
the appropriate section of each statute and regulation mandating or authorizing the
collection of information.
Pursuant to the Legislative Branch Appropriations Act of 1996, most of the claims
settlement functions performed by the General Accounting Office, now known as the
Government Accountability Office (GAO), were transferred to the Director, Office of
Management and Budget. See Sec. 211, Pub. L. 104-53, 109 Stat. 535. Subsequently,
the Acting Director delegated these functions to various components within the Executive
Branch in a determination order dated June 28, 1996. In summary, this order delegated to
the U.S. Office of Personnel Management (OPM) the authority to settle claims against
the United States involving Federal civilian employees’ compensation and leave,
deceased employees’ compensation, and proceeds of cancelled checks for veterans’
benefits payable to deceased beneficiaries. Congress then codified these changes through
additional legislation. See Pub.L. 104-316, 110 Stat. 3826. OPM promulgated
regulations at title 5, Code of Federal Regulations (CFR), part 178, setting forth detailed
procedures for settling claims.
2. Indicate how, by whom, and for what purpose the information is to be used. Except for a
new collection, indicate the actual use the agency has made of the information received
from the current collection.
5 CFR 178.205 (a) directs that the agency at which the deceased employee was last
employed request the appropriate person or persons to execute Standard Form (SF) 1153,
Claim for Unpaid Compensation of Deceased Civilian Employee. The collection of this
information is necessary to assist agencies and OPM with the distribution of deceased
employees’ compensation. If this information is not collected, agencies and OPM will
have difficulty or be inefficient in distributing these monies to the proper individuals.
In the event of a disputed claim, OPM reviews the information submitted by the claimant
and the agency and renders a decision on whether to grant or deny the claim. The
decision is documented in a synopsis which explains the facts of the claim and the
justification for the decision. The decision is then placed on OPM’s website, with any
identifying information removed
3. Describe whether, and to what extent, the collection of information involves the use of
automated, electronic, mechanical, or other technological collection techniques or other
forms of information technology, e.g., permitting electronic submission of responses, and
the basis for the decision for adopting this means of collection. Also describe any
consideration of using information technology to reduce burden.

Information collected on the SF 1153 is to be used by the employing agency and, in the
event of a disputed claim, by OPM to help determine the claimant’s and others’ rights to
the unpaid compensation.
4. Describe efforts to identify duplication. Show specifically why any similar information
already available cannot be used or modified for use for the purposes described in Item 2
above.
The forms are filed individually. Similar information is not available.
5.

If the collection of information impacts small businesses or other small entities (Item 5
of OMB Form 83-I), describe any methods used to minimize.
This information collection request has no impact on small businesses and organizations.

6. Describe the consequence to Federal/OPM program or policy activities if the collection
of information is not conducted, or is conducted less frequently, as well as any technical
or legal obstacles to reducing burden.
The collection of this information is performed as needed to assist agencies and OPM
with the distribution of deceased employees’ compensation. If this information is not
collected, agencies and OPM will have difficulty or be inefficient in distributing these
monies to the proper individuals. This could result in OPM making erroneous payments
to those who do not qualify for survivor benefits. This information collection is
consistent with the guidelines in 5 CFR 1320.6, except for 1320.6(b).
7. Explain any special circumstances that would cause an information collection to be
conducted in a manner: On January 22, 2018, a 60 Day Federal Register Notice was
published as required by 5 CFR 1320.
There were no comments received.
8. Federal Register Notice: Provide a copy and identify the date and page number of
publication in the Federal Register of the agency’s notice soliciting comments on the
information collection prior to submission to OMB
The information collection was previously published in the Federal Register on
January/22/2018 at Volume # 83 3034-3035 allowing for a 60-day public comment
period. No comments were received for this information collection.
9. Explain any decision to provide any payment or gift to respondents, other than remuneration
of contractors or grantees.
No gifts or payments of any kind have been provided to any individuals who are connected to
this collection.
10. Describe any assurance of confidentiality provided to respondents and the basis for the
assurance in statute, regulation, or agency policy.

This information collection is protected by the Privacy Act of 1974 and OPM regulations (5
CFR 831.106).
11. Provide additional justification for any questions of a sensitive nature, such as sexual
behavior and attitudes, religious beliefs, and other matters that are commonly considered
private. This justification should include the reasons why the agency considers the
questions necessary, the specific uses to be made of the information, the explanation to be
given to persons from whom the information is requested, and any steps to be taken to
obtain their consent.
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. Provide estimates of the hour burden of the collection of information. The statement
should:
a. Indicate the number of respondents, frequency of response, annual hour burden, and
an explanation of how the burden was estimated. Unless directed to do so, agencies
should not conduct special surveys to obtain information on which to base hour burden
estimates. Consultation with a sample (fewer than 10) of potential respondents is desired.
If the hour burden on respondents is expected to vary widely because of differences in
activity, size, or complexity, show the range of estimated hour burden, and explain the
reasons for the variance. Generally, estimates should not include burden hours for
customary and usual business practices.
b. If this request for approval covers more than one form, provide separate hour burden
estimates for each form and aggregate the hour burdens in Item 13 of OMB Form 83-I.
c. Provide estimates of annualized cost to respondents for the hour burdens for
collections of information, identifying and using appropriate wage rate categories. The
cost of contracting out or paying outside parties for information collection activities
should not be included here. Instead, this cost should be included in Item 14.
Approximately 3,000 forms will be processed annually. The form requires
approximately 15 minutes for completion. A burden of 750 hours is estimated.
Form Name

Form
Number

No. of
Respondents

No. of
Responses
per
Respondent

Claim for
Unpaid
Compensation
of Deceased
Civilian
Employee

SF-1153

3,000

1

Average
Burden
per
Response
(in hours)

15 minutes

Total
Annual
Burden
(in
hours)

750

Average
Hourly
Wage
Rate

$0

Total
Annual
Respondent
Cost

$0

There is no cost to the respondents.
The annualized cost to the Federal government is $30,000. This cost includes employee
salary hours devoted to the program, forms and overhead.
13. Provide an estimate of the total annual cost burden to respondents or recordkeepers
resulting from the collection of information. (Do not include the cost of any hour burden
shown in Items 12 and 14.)
The cost estimate should be split into two components: (1) a total capital and start-up
cost component (annualized over its expected useful life); and (b) a total operation and
maintenance and purchase of services component. The estimates should take into
account costs associated with generating, maintaining, and disclosing or providing the
information. Include descriptions of methods used to estimate major cost factors
including system and technology acquisition, expected useful life of capital equipment,
the discount rate(s), and the time period over which costs will be incurred. Capital and
start-up costs include, among other items, preparations for collecting information such as
purchasing computers and software; monitoring, sampling, drilling and testing
equipment; and record storage facilities.
There is no cost to the respondents resulting from the collection of this information.

14. If cost estimates are expected to vary widely, agencies should present ranges of cost
burdens and explain the reasons for the variance. The cost of purchasing or contracting
out information collection services should be a part of this cost burden estimate. In
developing cost burden estimates, agencies may consult with a sample of respondents
(fewer than 10), utilize the 60-day pre-OMB submission public comment process and use
existing economic or regulatory impact analysis associated with the rulemaking
containing the information collection as appropriate.
Generally, estimates should not include purchases of equipment or services, or portions
thereof, made: (1) prior to October 1, 1995, (2) to achieve regulatory compliance with
requirements not associated with the information collection, (3) for reasons other than to
provide information to keep records for the government, or (4) as part of customary and
usual business or private practices.
There is no change in the respondent burden.
15. Explain the reasons for any program changes or adjustments reported in Items 13 or
14 of the OMB Form 83-I. Changes in hour burden, i.e., program changes or adjustments
made to annual reporting and recordkeeping hour and cost burden. A program change is
the result of deliberate Federal government action. All new collections and any
subsequent revisions of existing collections (e.g., the addition or deletion of questions)
are recorded as program changes. An adjustment is a change that is not the result of a
deliberate Federal government action. These changes that result from new estimates or
actions not controllable by the Federal government are recorded as adjustments.

There are no program changes.
16. For collections of information whose results will be published, outline plans for
tabulation and publication. Address any complex analytical techniques that will be used.
Provide the time schedule for the entire project, including beginning and ending dates of
the collection of information, completion of report, publication dates, and other actions.
No information collected from the form will be published.
17. If seeking approval to not display the expiration date for OMB approval of the
information collection, explain reasons that display would be inappropriate.
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 information required by long-standing
statutory and regulatory 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. 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.
18. Explain each exception to the certification statement identified in Item 19
“Certification for Paperwork Reduction Act Submissions,” of OMB Form 83-I.
There are no exceptions to the certification statement.