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

ICR 200712-3206-005

OMB: 3206-0162

Federal Form Document

Forms and Documents
ICR Details
3206-0162 200712-3206-005
Historical Active 200411-3206-001
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 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
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 of good health. OPM Form 1530 collects this information and gives the physician permission to release such information to OPM.

US Code: 5 USC 8339(k)(I) Name of Law: Civil Service Retirement
  
None

Not associated with rulemaking

  72 FR 39094 07/17/2007
72 FR 73385 12/27/2007
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 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

$22,100
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Mary 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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