Report of Medical Examination of Person Electing Survivor Benefits under the Civil Service Retirement System

ICR 199804-3206-008

OMB: 3206-0162

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
3206-0162 199804-3206-008
Historical Active 199409-3206-001
OPM
Report of Medical Examination of Person Electing Survivor Benefits under the Civil Service Retirement System
Extension without change of a currently approved collection   No
Regular
Approved without change 06/17/1998
Retrieve Notice of Action (NOA) 04/24/1998
  Inventory as of this Action Requested Previously Approved
06/30/2001 06/30/2001 06/30/1998
500 0 500
750 0 750
0 0 0

Persons applying for retirement under the Civil Service Retirement System may elect an insurable interest survivor annuity if they are in good health. OPM needs medical evidence demonstrating the applicant's condition. OPM form 1530 is designed to collect this information and gives the physician permission to release such information to OPM.

None
None


No

1
IC Title Form No. Form Name
Report of Medical Examination of Person Electing Survivor Benefits under the Civil Service Retirement System 1530

  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 500 500 0 0 0 0
Annual Time Burden (Hours) 750 750 0 0 0 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.
04/24/1998


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