Information Collection

Death Benefit Payment Rollover Election Form

IC 33723 under ICR 201003-3206-002 · OMB 3206-0218.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0218 can be found here:

Documents and Forms

Document Name Document Type
Form RI 94-7 Death Benefit Payment Rollover Election Form Form and Instruction
RI 94-7 Death Benefit Payment Rollover Election RI94-007.pdf Form and Instruction
RI 94-007 April 2010 Markup for OMB.pdf RI 94-007 April 2010 Markup for OMB IC Document
RI 94-7 Dec 2005 Markup for OMB.pdf RI 94-7 Dec 2005 Markup for OMB IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Death Benefit Payment Rollover Election Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 26 CFR 1.402(f) 26 CFR 1.401(a)(31) 26 CFR 3405(c) 26 CFR 1. 402(c) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RI 94-7	Death Benefit Payment Rollover Election	RI94-007.pdf		No		Fillable Printable

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: 3,444	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	3,444	3,444
Annual IC Time Burden (Hours)	3,444	3,444
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
RI 94-007 April 2010 Markup for OMB	RI 94-007 April 2010 Markup for OMB.pdf	05/18/2010
RI 94-7 Dec 2005 Markup for OMB	RI 94-7 Dec 2005 Markup for OMB.pdf	05/18/2010

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