Information Collection

Notice Regarding Repayment of a Buyout Prior to Re-employment with the Federal Government

IC 19621 under ICR 200805-1545-011 · OMB 1545-1920.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1920 can be found here:

Documents and Forms

Document Name Document Type
Form 12311 Notice Regarding Repayment of a Buyout Prior to Re-employment with the Federal Government Form
12311 Repayment of a Federal Government Buyout and Possible Su Form 12311.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice Regarding Repayment of a Buyout Prior to Re-employment with the Federal Government	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	12311	Repayment of a Federal Government Buyout and Possible Suspension of Severance Pay	Form 12311.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 33,058	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	33,085	33,085
Annual IC Time Burden (Hours)	2,757	2,757
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.