Information Collection

Letter Reply to Request for Information. Former Spouse Survivor Annuity Election/Information on Electing a Survivor for Your Former Spouse

IC 33752 under ICR 202010-3206-013 · OMB 3206-0235.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 20-64 Letter Reply to Request for Information. Former Spouse Survivor Annuity Election/Information on Electing a Survivor for Your Former Spouse	Form
RI 20-64B September 2013.pdf	Instruction
RI 20-64 Letter Reply to Request for Information_Revised RI20-064_2020_08_Revised..pdf	Form
RI 20-64A Former Spouse Survivor Annuity Election_Revised RI 20-64A_2020_08_Revised.pdf	Form and Instruction

IC Title:

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 831.631 5 CFR 831.632

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	RI 20-64	Letter Reply to Request for Information_Revised	RI20-064_2020_08_Revised..pdf	Yes	No	Fillable Printable
Form and Instruction	RI 20-64A	Former Spouse Survivor Annuity Election_Revised	RI 20-64A_2020_08_Revised.pdf	No		Fillable Printable
Instruction			RI 20-64B September 2013.pdf	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: 38

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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	38	0	0	38
Annual IC Time Burden (Hours)	24	0	0	24
Annual IC Cost Burden (Dollars)	0	-633	633	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.