This collection
is approved for a year only. When re-submitted, OPM needs to
include the applicable SORN and PIA associated with this collection
and make any required changes.
Inventory as of this Action
Requested
Previously Approved
12/31/2017
36 Months From Approved
12/31/2016
13,450
0
13,450
12,775
0
12,775
0
0
0
SF 3112 collects information from
applicants for disability retirement so that OPM can determine
whether to approve a disability retirement. The applicant will only
complete Standard Forms 3112A and 3112C. Standard Forms 3112B,
3112D and 3112E will be completed by the immediate supervisor and
the employing agency of the applicant.
Charles Conyers 202 606-0125
charles.conyers@opm.gov
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.