CSRS/FERS Documentation in Support of Disability Retirement Application

SF 3112, CSRS/FERS Documentation in Support of Disability Retirement Application

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0228 can be found here:

Documents and Forms

Document Name Document Type
Form SF 3112 CSRS/FERS Documentation in Support of Disability Retirement Application Form and Instruction
SF 3112 Documentation in Support of Disability Retirement Applic SF3112_December2009_Updated.pdf Form and Instruction
SF3112_December2009_Updated_MarkUp.pdf SF 3112 December 2009 Markup IC Document
SF3112_Feb_2004 Markup.pdf SF3112 Feb 2004 Markup IC Document
SF3112-1.pdf SF3112-1 IC Document
SF3112-2.pdf SF3112-2 IC Document

Information Collection (IC) Details

IC Title:	CSRS/FERS Documentation in Support of Disability Retirement Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 844 Subpart C 5 CFR 831 Subpart L

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SF 3112	Documentation in Support of Disability Retirement Application	SF3112_December2009_Updated.pdf		No		Fillable Printable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records
Title: OPM/Central-1	FR Citation: 73 FR 15013

Number of Respondents: 13,450	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	13,450	13,450
Annual IC Time Burden (Hours)	12,775	12,775
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SF 3112 December 2009 Markup	SF3112_December2009_Updated_MarkUp.pdf	04/15/2010
SF3112 Feb 2004 Markup	SF3112_Feb_2004 Markup.pdf	04/15/2010
SF3112-1	SF3112-1.pdf	04/15/2010
SF3112-2	SF3112-2.pdf	04/15/2010

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