FORMER SPOUSE'S APPLICATION FOR SURVIVOR ANNUITY UNDER THE CIVIL SERVICE RETIREMENT SYSTEM

ICR 199410-3206-001

OMB: 3206-0158

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3206-0158 199410-3206-001
Historical Active 199112-3206-003
OPM
FORMER SPOUSE'S APPLICATION FOR SURVIVOR ANNUITY UNDER THE CIVIL SERVICE RETIREMENT SYSTEM
Revision of a currently approved collection   No
Regular
Approved without change 01/15/1995
Retrieve Notice of Action (NOA) 10/21/1994
  Inventory as of this Action Requested Previously Approved
12/31/1997 12/31/1997 01/31/1995
500 0 5,000
375 0 2,500
0 0 0

FORM OPM 1536 IS DESIGNED FOR USE BY FORMER SPOUSES OF FEDERAL EMPLOYE AND ANNUITANTS WHO ARE APPLYING FOR A MONTHLY CIVIL SERVICE RETIREMENT SYSTEM BENEFIT. THIS APPLICATION COLLECTS INFORMATION ABOUT WHETHER THE APPLICANT IS COVERED BY THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM AND ABOUT ANY COURT ORDER WHICH AWARDS THE APPLICANT RETIREMEN BENEFITS.

None
None


No

1
IC Title Form No. Form Name
FORMER SPOUSE'S APPLICATION FOR SURVIVOR ANNUITY UNDER THE CIVIL SERVICE RETIREMENT SYSTEM OPM 1536

  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 500 5,000 0 0 -4,500 0
Annual Time Burden (Hours) 375 2,500 0 0 -2,125 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
10/21/1994


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