Information Collection

Request to Disability Annuitant for Information on Physical Condition and Employment

IC 33615 under ICR 201703-3206-001 · OMB 3206-0143.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0143 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 30-1 Request to Disability Annuitant for Information on Physical Condition and Employment	Form and Instruction
RI 30-1 Request to Disability Annuitant for Information on Physi RI30-001_2016_11.pdf	Form and Instruction
RI30-001_2016_11_Justification.doc Justification	IC Document
RI30-001_2016_11_MarkUp.pdf Mark-Up of ICR to show Edits	IC Document

IC Title:

Request to Disability Annuitant for Information on Physical Condition and Employment

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 844.401 through 844.403 5 CFR 831.1206 through 831.1211 5 CFR 844.303 through 844.304

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RI 30-1	Request to Disability Annuitant for Information on Physical Condition and Employment	RI30-001_2016_11.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: OPM/Central-1

FR Citation: 75 FR 15013

Number of Respondents: 8,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	8,000	8,000
Annual IC Time Burden (Hours)	8,000	8,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	RI30-001_2016_11_Justification.doc	03/13/2017
Mark-Up of ICR to show Edits	RI30-001_2016_11_MarkUp.pdf	03/13/2017

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