Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System

OPM 1530, Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0162 can be found here:

Documents and Forms

Document Name Document Type
Form OPM 1530 Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System Form and Instruction
OPM 1530 Report of Medical Examination of Person Electing Survivo OPM 1530 Dec 2010.pdf Form and Instruction
OPM 1530 Sept 2004 Markup.pdf OPM 1530 Sept 2004 Markup IC Document
OPM 1530 Dec 2010 Markup.pdf OPM 1530 Dec 2010 Markup IC Document

Information Collection (IC) Details

IC Title:	Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System	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 831.613

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	OPM 1530	Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System	OPM 1530 Dec 2010.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: 500	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	500	500
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OPM 1530 Sept 2004 Markup	OPM 1530 Sept 2004 Markup.pdf	11/29/2010
OPM 1530 Dec 2010 Markup	OPM 1530 Dec 2010 Markup.pdf	11/29/2010

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