Information Collection

RI 38-117, Rollover Election

IC 33708 under ICR 201904-3206-001 · OMB 3206-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 38-117 Rollover Election RI 38-117, Rollover Election	Form and Instruction
Form RI 38-118 Rollover Information RI 38-117, Rollover Election	Form and Instruction
Form RI 38-118 Rollover Information RI 38-117, Rollover Election	Form and Instruction
Form RI 37-22 Special Tax Notice Regarding Rollovers RI 38-117, Rollover Election	Form and Instruction
Form RI N37-22 Special Tax Notice Regarding Rollovers RI 38-117, Rollover Election	Form and Instruction
RI 38-117 Rollover Election RI38-117_February2019_Revised.pdf	Form and Instruction
RI 38-118 Rollover Information RI38-118_2018_11Revised.pdf	Form and Instruction
RI 38-117 Rollover Election RI38-117_March2011_MarkUp.pdf	Form and Instruction
RI 38-118 Rollover Information RI38-118_September2009 Markup.pdf	Form and Instruction
RI 37-22 Special Tax Notice Regarding Rollovers RI 37-22 February2019_Revised.pdf	Form and Instruction
RI N37-22 Special Tax Notice Regarding Rollovers RI 37-22_March 2011_MarkUp.pdf	Form and Instruction

IC Title:

RI 38-117, Rollover Election

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RI 38-117	No		Printable Only
Form and Instruction	RI 38-118	No		Paper Only
Form and Instruction	RI 38-118	No		Paper Only
Form and Instruction	RI 37-22	Yes	No	Printable Only
Form and Instruction	RI N37-22	Yes	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: 1,500

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,500	0	1,500
Annual IC Time Burden (Hours)	1,000	0	1,000
Annual IC Cost Burden (Dollars)	60,249	60,249	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.

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