Annuitant Pledge Form

Combined Federal Campaign (CFC) Form 1654-B (Retiree Pledge Form)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0271 can be found here:

Documents and Forms

Document Name Document Type
2017 CFC Donor Pledge System Screen Shots.pdf Donor Pledge System IC Document
CFC Paper Retirement Enrollment - 11272017.docx CFC Paper Retirement Enrollment IC Document

Information Collection (IC) Details

IC Title:	Annuitant Pledge Form	Agency IC Tracking Number:	OPM 1654B

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 950

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

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 50169

Number of Respondents: 250,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	Approved	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

Title	Document	Date Uploaded
Donor Pledge System	2017 CFC Donor Pledge System Screen Shots.pdf	11/02/2017
CFC Paper Retirement Enrollment	CFC Paper Retirement Enrollment - 11272017.docx	11/30/2017

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