Information Collection

Annuity Supplement Earnings Report

IC 33678 under ICR 202101-3206-003 · OMB 3206-0194.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0194 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 92-22 Annuity Supplement Earnings Report	Form and Instruction
RI 92-22 Annuity Supplement Earnings Report RI92-022_2021_03.pdf www.opm.gov	Form and Instruction
RI 92-22 Annuity Supplement Earnings Report RI92-022_2021_03.pdf www.opm.gov	Form and Instruction
RI 92-22 Annuity Supplement Earnings Report RI92-022_2021_03_MarkUp.pdf www.opm.gov	Form and Instruction
RI 92-22 Annuity Supplement Earnings Report RI92-022_2021_03_MarkUp.pdf www.opm.gov	Form and Instruction

IC Title:

Annuity Supplement Earnings Report

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 842.505 5 CFR 842.504

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 92-22	Annuity Supplement Earnings Report	RI92-022_2021_03.pdf	www.opm.gov	Yes	No	Fillable Printable
Form and Instruction	RI 92-22	Annuity Supplement Earnings Report	RI92-022_2021_03_MarkUp.pdf	www.opm.gov	Yes	No	Fillable Printable

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: 13,000

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	Previously Approved
Annual Number of Responses for this IC	13,000	0	13,000
Annual IC Time Burden (Hours)	3,250	0	3,250
Annual IC Cost Burden (Dollars)	87,282	87,282	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.