RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit

ICR 201401-3206-004

OMB: 3206-0254

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2014-01-27
Supplementary Document
2014-01-27
Supporting Statement A
2014-01-27
IC Document Collections
ICR Details
3206-0254 201401-3206-004
Historical Active 201010-3206-005
OPM
RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit
Extension without change of a currently approved collection   No
Regular
Approved without change 03/25/2014
Retrieve Notice of Action (NOA) 02/18/2014
  Inventory as of this Action Requested Previously Approved
03/31/2017 36 Months From Approved 03/31/2014
100 0 720
8 0 60
0 0 0

Form RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit is available only on the OPM website. It is used by retirees separated for disability and the survivors of retirees separated for disability to request that Retirement Operations review the computations of disability annuities to include the formulae provided in law for individuals who performed service as law enforcement officers, firefighters, nuclear materials carriers, air traffic controllers, Congressional employees, and Capitol and Supreme Court police.

US Code: 5 USC 8337 Name of Law: Disability Retirement (CSRS)
   US Code: 5 USC 8339 Name of Law: Computation of Annuity (CSRS)
   US Code: 5 USC 8452 Name of Law: Computation of disability annuity (FERS)
  
None

Not associated with rulemaking

  78 FR 52580 08/23/2013
79 FR 3880 01/23/2014
No

1
IC Title Form No. Form Name
RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit RI 20-123 Request for Case Review for Enhanced Disability Annuity Benefit

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 100 720 0 -620 0 0
Annual Time Burden (Hours) 8 60 0 -52 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
The annual burden has decreased because we have not received the anticipated number of responses. Since the initial inception of this form, it appears that the majority of individuals affected has contacted OPM and have received a response.

$5,550
No
No
No
No
No
Uncollected
Steve Pierce 202 606-2560 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/18/2014


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