Information Collection

CFC Annunitant Pledge Form

IC 228658 under ICR 201710-3206-003 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OPM 1654 B CFC Annunitant Pledge Form	Form and Instruction
OPM 1654 B CFC Annuitant Pledge Form CFC Paper Retirement Enrollment - 10123017.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

OPM 1654 B

Is this a Common Form? Yes

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 950

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	OPM 1654 B	CFC Annuitant Pledge Form	CFC Paper Retirement Enrollment - 10123017.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: Combined Federal Campaign Annunitnt Pledge

FR Citation: 82 FR 161

Number of Respondents: 250,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250,000	250,000
Annual IC Time Burden (Hours)	125,000	125,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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