Annuitant Pledge Form

Combined Federal Campaign (CFC) Form 1654-B (Retiree Pledge Form)

Documents and Forms

Document Name Document Type
508 2020 CFC Retiree Pledge Form ICR 3206 0271.pdf CFC Pledge Form IC Document
508 2020 CFC Retiree Pledge Form ICR 3206 0271.pdf CFC Pledge Form IC Document
CFC Donor Pledging System Screen Shots 2020.pdf CFC Donor Pledge System Screen Shots IC Document
CFC Donor Pledging System Screen Shots 2020.pdf CFC Donor Pledge System Screen Shots IC Document

Information Collection (IC) Details

IC Title:	Annuitant Pledge Form	Agency IC Tracking Number:	OPM 1654B

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 950

Information Collection 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: 85 FR 42444

Number of Respondents: 250,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	250,000	0	250,000
Annual IC Time Burden (Hours)	125,000	0	125,000
Annual IC Cost Burden (Dollars)	408,175	408,175	0

Documents for IC

Title	Document	Date Uploaded
CFC Pledge Form	508 2020 CFC Retiree Pledge Form ICR 3206 0271.pdf	09/28/2020
CFC Donor Pledge System Screen Shots	CFC Donor Pledging System Screen Shots 2020.pdf	09/28/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.