We Need Important Information About Your Eligibility for Social Security Disability Benefits

ICR 200712-3206-003

OMB: 3206-0216

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2007-12-20
Supplementary Document
2007-12-20
ICR Details
3206-0216 200712-3206-003
Historical Active 200410-3206-001
OPM
We Need Important Information About Your Eligibility for Social Security Disability Benefits
Revision of a currently approved collection   No
Regular
Approved without change 02/08/2008
Retrieve Notice of Action (NOA) 12/27/2007
  Inventory as of this Action Requested Previously Approved
02/28/2011 36 Months From Approved 02/29/2008
3,000 0 3,000
250 0 250
0 0 0

The information provided by the annuitant is used by OPM to verify receipt of SSA disability benefits, make necessary adjustments to the FERS disability benefit, and notify the annuitant of any overpayment payable to OPM. It also notifies the annuitant of the responsibility to notify OPM if SSA benefits begin and the consequences of non-notification.

US Code: 5 USC Chapter 84 Name of Law: Federal Employees Retirement System
   US Code: 5 USC Chapter 84, Section 8452 Name of Law: Computation of Disability Annuity
  
None

Not associated with rulemaking

  72 FR 37276 07/09/2007
72 FR 71168 12/14/2007
No

  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 3,000 3,000 0 0 0 0
Annual Time Burden (Hours) 250 250 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$18,900
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Mary Beth Smith-Toomey 202-606-8358 [email protected]

  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.
12/27/2007


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