Information Collection

Annuity Supplement Earnings Report

IC 33678 under ICR 201004-3206-012 · OMB 3206-0194.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0194 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 92-22 Annuity Supplement Earnings Report	Form and Instruction
RI 92-22 Annuity Supplement Earnings Report RI 92-022.pdf	Form and Instruction
RI 92-022 March 2010 Markup.pdf RI 99-022 March 2010 Markup	IC Document
RI 92-22 April 2009 Markup.pdf RI 92-22 April 2009 Markup	IC Document

IC Title:

Annuity Supplement Earnings Report

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 842.505 5 CFR 842.504

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RI 92-22	Annuity Supplement Earnings Report	RI 92-022.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: 13,000

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	Previously Approved
Annual Number of Responses for this IC	13,000	13,000
Annual IC Time Burden (Hours)	3,250	3,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
RI 99-022 March 2010 Markup	RI 92-022 March 2010 Markup.pdf	04/15/2010
RI 92-22 April 2009 Markup	RI 92-22 April 2009 Markup.pdf	04/15/2010

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