DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION

ICR 198401-3206-001

OMB: 3206-0133

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3206-0133 198401-3206-001
Historical Active
OPM
DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 04/11/1984
Retrieve Notice of Action (NOA) 01/13/1984
Request for exemption to the requirements for printing the OMB expiration date on the forms is denied.
  Inventory as of this Action Requested Previously Approved
04/30/1987 04/30/1987
15,000 0 0
15,000 0 0
0 0 0

THESE FORMS STIPULATE THE DOCUMENTATION AND ELIGIBLITY REQUIREMENTS FOR DISABILITY RETIREMENT. THE INFORMATION COLLECTED ON AND THE SUPPORTING DOCUMENTATION SUBMITTED WITH THE FORMS IS THE BASIS FOR OPM'S ALLOWANCE OR DISALLOWANCE OF DISABILITY RETIREMENT APPLICATIONS FILED BY FEDERAL EMPLOYEES.

None
None


No

1
IC Title Form No. Form Name
DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION

  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 15,000 0 0 15,000 0 0
Annual Time Burden (Hours) 15,000 0 0 15,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
01/13/1984


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