Information Collection

Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84

IC 218495 under ICR 201905-3206-003 · OMB 3206-0268.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0268 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 20-126 Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84	Form and Instruction
RI 20-126 Certification of Qualifying District of Columbia Service RI20-126_2019_05_MarkUp.pdf www.opm.gov	Form and Instruction
RI 20-126 Certification of Qualifying DC Service Under Section 190 RI20-126_2019_05.pdf www.opm.gov	Form and Instruction

IC Title:

Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.1

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
Form and Instruction	RI 20-126	Certification of Qualifying DC Service Under Section 1905 of PL 111-84	RI20-126_2019_05.pdf	www.opm.gov	Yes	No	Fillable Printable
Form and Instruction	RI 20-126	Certification of Qualifying District of Columbia Service Under Section 1905 of P.L. 111-84	RI20-126_2019_05_MarkUp.pdf	www.opm.gov	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records

Title: OPM/ Central-1

FR Citation: 73 FR 1503

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,000	0	1,000
Annual IC Time Burden (Hours)	500	0	500
Annual IC Cost Burden (Dollars)	13,437	13,437	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.