RI 38-117, Rollover Election

RI 38-117, Rollover Election, RI 37-118, Rollover Information, and RI 37-22, Special Tax Notice Regarding Rollovers

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form RI 38-117 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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RI 38-117	Rollover Election	RI38-117_February2019_Revised.pdf	No		Printable Only
Form and Instruction	RI 38-118	Rollover Information	RI38-118_2018_11Revised.pdf	No		Paper Only
Form and Instruction	RI 38-117	Rollover Election	RI38-117_March2011_MarkUp.pdf	Yes	No	Printable Only
Form and Instruction	RI 38-118	Rollover Information	RI38-118_September2009 Markup.pdf	No		Paper Only
Form and Instruction	RI 37-22	Special Tax Notice Regarding Rollovers	RI 37-22 February2019_Revised.pdf	Yes	No	Printable Only
Form and Instruction	RI N37-22	Special Tax Notice Regarding Rollovers	RI 37-22_March 2011_MarkUp.pdf	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 %

	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

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.