Information Collection

Annuitant Pledge Form

IC 228913 under ICR 201711-3206-001 · OMB 3206-0271.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.