RI 30-1, Request to Disability Annuitant for Information on Physical Condition and Employment

Forms and Documents

Document Name	Status
RI30-001_OMBSupportingStatement_2016_05_02.docx Supporting Statement A	2016-06-28
RI30-001_2016_06_MarkUp.pdf Supplementary Document	2016-06-28
RI30-001_2013_06_MarkUp.pdf Supplementary Document	2016-06-28
RI30-001_60-DayFRN_Published_2016_04_20.pdf Supplementary Document	2016-06-28
RI30-001_30DayFRN_Published_2016_06_22.pdf Supplementary Document	2016-06-28

IC Document Collections

IC ID	Document Title	Status
33615	Request to Disability Annuitant for Information on Physical Condition and Employment	Modified

ICR Details

OMB Control No: 3206-0143	ICR Reference No: 201606-3206-005
Status: Historical Active	Previous ICR Reference No: 201303-3206-007
Agency/Subagency: OPM	Agency Tracking No:
Title: RI 30-1, Request to Disability Annuitant for Information on Physical Condition and Employment
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/12/2016
	Date Received in OIRA: 06/28/2016
Terms of Clearance: This collection is approved for a year only. When resubmitted, OPM should include the applicable SORN or PIA as well as determine if the privacy act statement should be revised.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved	12/31/2016
Responses	8,000	0	8,000
Time Burden (Hours)	8,000	0	8,000
Cost Burden (Dollars)	0	0	0

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Abstract: Persons who are not yet age 60 and who are receiving disability annuity are subject to inquiry as to their medical condition as OPM deems reasonably necessary. RI 30-1 collects information as to whether the disabling condition has changed. This ICR was revised to: (1) add a field for the claim number on page 2; (2) update the Room number; and (3) to update the zip code.

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Authorizing Statute(s): US Code: 5 USC 83 Section 8337 Name of Law: CSRS, Disability Retirement
   US Code: 5 USC 84 Section 8454 Name of Law: FERS, Medical Examination
   US Code: 5 USC 84 Section 8455 Name of Law: FERS, Recovery & Restoration of Earning Capacity
   US Code: 5 USC 84 Section 8464a Name of Law: FERS, Relationship between annuity and workers' compensation
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 76	04/20/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 120	06/22/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Request to Disability Annuitant for Information on Physical Condition and Employment	RI 30-1

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ICR Summary of Burden

	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	8,000	8,000	0	0	0	0
Annual Time Burden (Hours)	8,000	8,000	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $93,900

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 06/28/2016

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