Notices of Amount Due Because of Annuity Overpayment

RI 34-1, 34-17, Financial Resources Questionnaire, RI 34-3, RI 34-19, Notice of Amount Due Because of Annuity Overpayment and RI 34-20, Notice of Amount Due Because of FEHB Premium Underpayment.

OMB: 3206-0167

IC ID: 33642

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0167 can be found here:

Documents and Forms

Document Name Document Type
Form RI 34-20 Notices of Amount Due Because of Annuity Overpayment Form and Instruction
RI 34-17 Financial Resources Questionnaire RI 34-017_2018_06_Revised.pdf Form and Instruction
RI 34-18 Financial Resources Questionnaire RI 34-018_2018_06_Revised.pdf Form and Instruction
RI 34-19 Notice of Amount Due Because of FEGLI Premium Underpayme RI 34-019_2018_06_Revised.pdf Form and Instruction
RI 34-20 Notice OF Amount Due Because of FEHB Premium Underpaymen RI 34-020_2018_06_Revised.pdf Form and Instruction
RI 34-1 Financial Resources Questionnaire RI 34-001_2018_06_Revised.pdf Form and Instruction
RI 34-3 Notice of Amount Due Because of Annuity Overpayment RI 34-003_2018_06_Revised.pdf Form and Instruction
RI 34-1 Financial Resources Questionnaire (Markup) RI34-001_2012_05_MarkUp.pdf Form and Instruction
RI 34-3 Notice of Amount Due Because of Annuity Overpayment (Mar RI 34-003 December 2012_MarkUp.pdf Form and Instruction
RI 34-17 Financial Resources Questionnaire (Markup) RI 34-017 May 2012_MarkUp.pdf Form and Instruction
RI 34-18 Financial Resources Questionnaire (Markup) RI 34-018 Dec 2012_MarkUp.pdf Form and Instruction
RI 34-19 Notice of Amount Due Because of FEGLI Premium Underpayme RI34-019_2012_12_MarkUp.pdf Form and Instruction
RI 34-20 Notice of Amount Due Because of FEHB Premium Underpaymen RI 34-20 December 2012_MarkUp.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notices of Amount Due Because of Annuity Overpayment	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 845 5 CFR 831 Subpart M and N

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RI 34-20	Notice of Amount Due Because of FEHB Premium Underpayment (Markup)	RI 34-20 December 2012_MarkUp.pdf	No		Paper Only
Form and Instruction	RI 34-17	Financial Resources Questionnaire	RI 34-017_2018_06_Revised.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 34-18	Financial Resources Questionnaire	RI 34-018_2018_06_Revised.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 34-19	Notice of Amount Due Because of FEGLI Premium Underpayment	RI 34-019_2018_06_Revised.pdf	No		Paper Only
Form and Instruction	RI 34-20	Notice OF Amount Due Because of FEHB Premium Underpayment	RI 34-020_2018_06_Revised.pdf	No		Paper Only
Form and Instruction	RI 34-1	Financial Resources Questionnaire	RI 34-001_2018_06_Revised.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 34-3	Notice of Amount Due Because of Annuity Overpayment	RI 34-003_2018_06_Revised.pdf	No		Paper Only
Form and Instruction	RI 34-1	Financial Resources Questionnaire (Markup)	RI34-001_2012_05_MarkUp.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 34-3	Notice of Amount Due Because of Annuity Overpayment (Markup)	RI 34-003 December 2012_MarkUp.pdf	No		Paper Only
Form and Instruction	RI 34-17	Financial Resources Questionnaire (Markup)	RI 34-017 May 2012_MarkUp.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 34-18	Financial Resources Questionnaire (Markup)	RI 34-018 Dec 2012_MarkUp.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 34-19	Notice of Amount Due Because of FEGLI Premium Underpayment (Markup)	RI34-019_2012_12_MarkUp.pdf	No		Paper Only

Federal Enterprise Architecture Business Reference Module

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: 2,361	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,361	280	2,081
Annual IC Time Burden (Hours)	2,361	280	2,081
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.