DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
157027	DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION Form	Migrated

ICR Details

OMB Control No: 3206-0171	ICR Reference No: 199206-3206-006
Status: Historical Active	Previous ICR Reference No: 198905-3206-001
Agency/Subagency: OPM	Agency Tracking No:
Title: DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/08/1992
	Date Received in OIRA: 06/11/1992
Terms of Clearance: This request, as amended by the changes provided by OPM on 8/27/92, is given approval through 10/93. In light of the complexity of this form, OPM should study over the next year ways to make the format of the background material and instructions more seperately distinguishable to the user of this form. OPM's next request for OMB approval--to be submitted no later than 90 days before the 10/93 expiration date must reflect thorough consideration of alternative formats. As an alternative to printing this revised Standard Form to be used on a temporary basis through 10/93, OPM may continue to use the curren version of this form until an alternative version reflecting a changed format is developed and receives OMB approval. Approval to continue using the current version of the form also expires 10/93. Should OPM use the new version the following specific changes must be made on the newly-printed form: (1) The reference on p. 3 to "steps 1a or 1b" must be changed or two items appearing above it must be labeled as 1a and 1b. (2) The statement appearing opposite item 2 on p. 6 stating "FERS records are filed by name and date of birth" must be deleted, consistent with the other deletions of explanations. **Because OPM has apparently used this and other forms after expiratio dates since it has failed to submit requests for OMB approval less than 90 days from expiration of approval, OMB will consider discontinuing this policy for all OPM forms.***

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/1993	10/31/1993	08/31/1992
Responses	2,100	0	1,450
Time Burden (Hours)	3,150	0	1,450
Cost Burden (Dollars)	0	0	0

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Abstract: STANDARD FORM 3105 A-E ARE THE INSTRUMENTS BY WHICH AN EMPLOYEE PARTICIPATING IN THE FEDERAL EMPLOYEES RETIREMENT SYSTEM (FERS) APPLIE FOR RETIREMENT ON THE BASIS OF DISABILITY. THESE FORMS ARE THE MEANS BY WHICH OPM CAN OBTAIN THE DOCUMENTATION NECESSARY TO DETERMINE IF TH APPLICANT MEETS THE QUALIFICATIONS FOR DISABILITY RETIREMENT.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

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
DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION	SF 3105

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ICR Summary of Burden

	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	2,100	1,450	0	0	650	0
Annual Time Burden (Hours)	3,150	1,450	0	0	1,700	0
Annual Cost Burden (Dollars)	0	0	0	0	0	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: $0

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 06/11/1992

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