Information Collection

Letter Reply to Request for Information. Former Spouse Survivor Annuity Election/Information on Electing a Survivor for Your Former Spouse

IC 33752 under ICR 201703-3206-006 · OMB 3206-0235.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0235 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 20-64 Letter Reply to Request for Information. Former Spouse Survivor Annuity Election/Information on Electing a Survivor for Your Former Spouse	Form
RI 20-64B September 2013.pdf	Instruction
RI 20-64 Letter Reply to Request for Information RI20-064.pdf	Form
RI 20-64A Former Spouse Survivor Annuity Election RI 20-64A.pdf	Form and Instruction
RI20-064_Published30DayFRN_2017_03_13.pdf 30 Day Published FRN RI 20-64	IC Document
RI20-064_OMB_Supporting_Statement_csb_2016_11_14.doc RI20-064_OMB_Supporting_Statement_csb_2016_11_14	IC Document

IC Title:

Letter Reply to Request for Information. Former Spouse Survivor Annuity Election/Information on Electing a Survivor for Your Former Spouse

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 831.631 5 CFR 831.632

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	RI 20-64	Letter Reply to Request for Information	RI20-064.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 20-64A	Former Spouse Survivor Annuity Election	RI 20-64A.pdf	No		Fillable Printable
Instruction			RI 20-64B September 2013.pdf	No		Printable Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: OPM/Central-1

FR Citation: 73 FR 15013

Number of Respondents: 38

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	38	38
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
30 Day Published FRN RI 20-64	RI20-064_Published30DayFRN_2017_03_13.pdf	03/23/2017
RI20-064_OMB_Supporting_Statement_csb_2016_11_14	RI20-064_OMB_Supporting_Statement_csb_2016_11_14.doc	03/23/2017

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