Information Collection

RI 38-117, Rollover Election

IC 33708 under ICR 200911-3206-005 · OMB 3206-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 38-118 RI 38-117, Rollover Election	Form and Instruction
RI 38-117 Rollover Election RI38-117_October2009.pdf	Form and Instruction
RI 38-118 Rollover Information RI38-118_January2010[1].pdf	Form and Instruction
RI 37-22 Special Tax Notice Regarding Rollovers RI37-022_April2009.pdf www.opm.gov/retire/pubs/pamphlets/forms/RI37-22.pdf	Form and Instruction
RI38-117_October2009_MarkUp.pdf RI 38-117_October 2009_MarkUp	IC Document
RI38-117_November2008 Markup.pdf RI38-117_November2008 Markup	IC Document
RI38-118_September2009 Markup.pdf RI38-118_September2009 Markup	IC Document
Ri38-118 July 2002 Markup.pdf RI38-118 July2002 Markup	IC Document
RI37-022 April 2009 Markup.pdf RI37-022 April 2009 Markup	IC Document
Ri37-22 November 2008 Markup.pdf RI37-022_November2008 Markup	IC Document
RI38-118_January2010 Markup[1].pdf Revised 38-118 January 2010	IC Document

IC Title:

RI 38-117, Rollover Election

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Electronic Capability
Form and Instruction	RI 38-118	Rollover Information	RI38-118_January2010[1].pdf		No	Fillable Printable
Form and Instruction	RI 38-117	Rollover Election	RI38-117_October2009.pdf		No	Fillable Printable
Form and Instruction	RI 37-22	Special Tax Notice Regarding Rollovers	RI37-022_April2009.pdf	http://www.opm.gov/retire/pubs/pamphlets/forms/RI37-22.pdf	No	Printable Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: OPM/Central-1

FR Citation: 73 FR 15013

Number of Respondents: 1,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,500	0	1,500
Annual IC Time Burden (Hours)	1,000	250	750
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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