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....

Forms and Documents

Document Name	Status
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	Unchanged
SF3106_September2013.pdf Supplementary Document	2016-07-20
SF3106_3106A_60DayFRNPublished_2016_04_20.pdf Supplementary Document	2016-07-20
SF 3106 Published 30 Day FRN.pdf Supplementary Document	2016-07-20
SF3106_3106A_OMBSuppStmt_2016_06_13.doc Supporting Statement A	2016-07-20

IC Document Collections

IC ID	Document Title	Status
33648	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	Unchanged

ICR Details

OMB Control No: 3206-0170	ICR Reference No: 201607-3206-005
Status: Historical Active	Previous ICR Reference No: 201307-3206-004
Agency/Subagency: OPM	Agency Tracking No:
Title: 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....
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/12/2016
	Date Received in OIRA: 07/20/2016
Terms of Clearance: This collection approved for a year only. When resubmitted, OPM needs to include the applicable SORN and PIA as well as determine if the Privacy Statement needs to be rewritten to better describe the routine uses of this information.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved	12/31/2016
Responses	14,400	0	14,400
Time Burden (Hours)	4,533	0	4,533
Cost Burden (Dollars)	0	0	0

---

Abstract: SF 3106 is used by former Federal employees under the Federal Employees Retirement System, to apply for a refund of retirement deductions withheld during Federal employment, plus any interest provided by law. SF 3106A is used by refund applicants to notify their current/former spouse(s) that they are applying for a refund of retirement deductions, which is required by law.

---

Authorizing Statute(s): PL: Pub.L. 111 - 84 Title XIX Name of Law: Federal Employee Benefits
   US Code: 5 USC Chapter 84 Name of Law: Federal Employees Retirement System
  

Citations for New Statutory Requirements: None

---

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

---

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 132	07/11/2016
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
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/SF 3106A	Application for Refund of Retirement Deductions/Current/Former Spouse's Notification of Application for Refund of Retirement Deductions

---

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	14,400	14,400	0	0	0	0
Annual Time Burden (Hours)	4,533	4,533	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:

---

Annual Cost to Federal Government: $136,512

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

---

Common Form ICR:  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:

(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: 07/20/2016

---