Application for Refund of Retirement Deductions/Federal Employees Retirement System (SF 3106) Current/Former Spouse's Notification of Application for Refund of Retirement Deductions Under the....

SF 3106, Application for Refund of Retirement Deductions (FERS); SF 3106A, Current/Former Spouse's Notification of Application for Refund of Retirement Deductions Under the....

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0170 can be found here:

Documents and Forms

Document Name Document Type
Form SF 3106/SF 3106A Application for Refund of Retirement Deductions/Federal Employees Retirement System (SF 3106) Current/Former Spouse's Notification of Application for Refund of Retirement Deductions Under the.... Form and Instruction
SF 3106/SF 3106A Application for Refund of Retirement Deductions Federal SF3106_October2010.pdf Form and Instruction
SF3106_October2010_MarkUp.pdf SF 3106 Oct 2010 Markup IC Document
SF 3106 (05-09) Mark up.pdf SF 3106 May 2009 Markup IC Document

Information Collection (IC) Details

IC Title:	Application for Refund of Retirement Deductions/Federal Employees Retirement System (SF 3106) Current/Former Spouse's Notification of Application for Refund of Retirement Deductions Under the....	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 843 5 CFR 842

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SF 3106/SF 3106A	Application for Refund of Retirement Deductions Federal Employees Retirement System (FERS)/Current/Former Spouse(s) Notification of Application for Refund of Retirement Deductions Under FERS	SF3106_October2010.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: 14,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	14,400	-16,200	30,600
Annual IC Time Burden (Hours)	4,533	-5,100	9,633
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SF 3106 Oct 2010 Markup	SF3106_October2010_MarkUp.pdf	06/16/2010
SF 3106 May 2009 Markup	SF 3106 (05-09) Mark up.pdf	06/16/2010

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