Skip to Content
Notice

Submission for Review: SF 3104, Application for Death Benefits Under the Federal Employees Retirement System; and SF 3104B, Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee at the Time of Death

Action

60 Day Notice And Request For Comments.

Summary

Retirement Services, Office of Personnel Management (OPM) offers the general public and other federal agencies the opportunity to comment on a revised information collection request (ICR) 3206-0172, Application for Death Benefits under the Federal Employees Retirement System and Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee at the Time of Death. As required by the Paperwork Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. chapter 35) as amended by the Clinger-Cohen Act (Pub. L. 104-106), OPM is soliciting comments for this collection. The Office of Management and Budget is particularly interested in comments that:

1. Evaluate whether the proposed collection of information is necessary for the proper performance of functions of the agency, including whether the information will have practical utility;

2. Evaluate the accuracy of the agency's estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used;

3. Enhance the quality, utility, and clarity of the information to be collected; and

4. Minimize the burden of the collection of information on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submissions of responses.

 

Table of Contents Back to Top

DATES: Back to Top

Comments are encouraged and will be accepted until May 21, 2012. This process is conducted in accordance with 5 CFR 1320.1.

ADDRESSES: Back to Top

Interested persons are invited to submit written comments on the proposed information collection to U.S. Office of Personnel Management, Quinta Spear, Deputy Assistant Director, Retirement Operations, Retirement Services, 1900 E Street NW., US 300, Washington, DC 20415, or sent via electronic mail to Leslie.Parker@opm.gov.

FOR FURTHER INFORMATION CONTACT: Back to Top

A copy of this ICR, with applicable supporting documentation, may be obtained by contacting the Retirement Services Publications Team, Office of Personnel Management, 1900 E Street NW., Room 4332, Washington, DC 20415, Attention: Cyrus S. Benson or sent via electronic mail to Cyrus.Benson@opm.gov or faxed to (202) 606-0910.

SUPPLEMENTARY INFORMATION: Back to Top

SF 3104, Application for Death Benefits under the Federal Employees Retirement System, is needed to collect information so that OPM can pay death benefits to the survivors of Federal employees and annuitants. SF 3104B, Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee at the Time of Death, is needed for deaths in service so that survivors can make the needed elections regarding health benefits, military service and payment of the death benefit.

Analysis Back to Top

Agency: Retirement Operations, Retirement Services, Office of Personnel Management

Title: Application for Death Benefits under the Federal Employees Retirement System and Documentation and Elections in Support of Application for Death Benefits When Deceased Was an Employee at the Time of Death.

OMB Number: 3206-0172.

Frequency: On occasion.

Affected Public: Individuals or Households.

Number of Respondents: SF 3104 = 12,734 and SF 3104B = 4,017.

Estimated Time per Respondent: 60 minutes.

Total Burden Hours: 16,751.

U.S. Office of Personnel Management.

John Berry,

Director.

[FR Doc. 2012-6783 Filed 3-20-12; 8:45 am]

BILLING CODE 6325-38-P

Site Feedback