Information Collection

Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....

IC 33658 under ICR 202102-3206-003 · OMB 3206-0174.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0174 can be found here:

2024-06-30 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 20-117_ROC Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....	Form and Instruction
RI 20-63 Survivor Annuity Election for a Spouse RI20-063_2018_02.pdf	Form and Instruction
RI 20-63 Survivor Annuity Election for a Spouse RI20-063_2018_02.pdf	Form and Instruction
RI 20-116 Information about the Cost to Elect Less Than the Maximu RI20-116_2016_08_DC_MarkUp.pdf	Form and Instruction
RI 20-116 Information about the Cost to Elect Less Than the Maximu RI20-116_2016_08_DC_MarkUp.pdf	Form and Instruction
RI 20-116 Information about the Cost to Elect Less Than the Maximu RI20-116_2021_02_DC_Revised.pdf	Form and Instruction
RI 20-116 Information about the Cost to Elect Less Than the Maximu RI20-116_2021_02_DC_Revised.pdf	Form and Instruction
RI 20-117_DC Information about the Cost to Elect the Maximum Survivor RI20-117_2016_08_DC_MarkUp.pdf	Form and Instruction
RI 20-117_DC Information about the Cost to Elect the Maximum Survivor RI20-117_2016_08_DC_MarkUp.pdf	Form and Instruction
RI 20-117_DC Information about the Cost to Elect teh Maximum Survivor RI20-117_2021_02_DC_Revised.pdf	Form and Instruction
RI 20-117_DC Information about the Cost to Elect teh Maximum Survivor RI20-117_2021_02_DC_Revised.pdf	Form and Instruction
RI 20-117_ROC Survivor Annuity Election for a Spouse RI20-117_2016_08_ROC_Mark Up.pdf	Form and Instruction
RI 20-117_ROC Survivor Annuity Election for a Spouse RI20-117_2016_08_ROC_Mark Up.pdf	Form and Instruction
RI 20-63 Survivor Annuity Election for a Spouse RI20-063_2021_02_Revised.pdf	Form and Instruction
RI 20-63 Survivor Annuity Election for a Spouse RI20-063_2021_02_Revised.pdf	Form and Instruction
RI 20-117_ROC Information about the Cost to Elect the Maximum Survivor RI20-117_2021_02_ROC_Revised.pdf	Form and Instruction
RI 20-117_ROC Information about the Cost to Elect the Maximum Survivor RI20-117_2021_02_ROC_Revised.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Survivor Annuity Election for a Spouse/Cover Letter Giving Information About the Cost to Elect Less Than the Maximum Survivor Annuity/Cover Letter Giving Information About the....

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 842.612 5 CFR 831.631 5 CFR 842.613 5 CFR 842.614 5 CFR 842.611 5 CFR 842.615 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 and Instruction	RI 20-63	Survivor Annuity Election for a Spouse	RI20-063_2018_02.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 20-116	Information about the Cost to Elect Less Than the Maximum Survivor Annuity	RI20-116_2016_08_DC_MarkUp.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 20-116	Information about the Cost to Elect Less Than the Maximum Survivor Annuity	RI20-116_2021_02_DC_Revised.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 20-117_DC	Information about the Cost to Elect the Maximum Survivor Annuity	RI20-117_2016_08_DC_MarkUp.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 20-117_DC	Information about the Cost to Elect teh Maximum Survivor Annuity	RI20-117_2021_02_DC_Revised.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 20-117_ROC	Survivor Annuity Election for a Spouse	RI20-117_2016_08_ROC_Mark Up.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 20-63	Survivor Annuity Election for a Spouse	RI20-063_2021_02_Revised.pdf	Yes	No	Fillable Printable
Form and Instruction	RI 20-117_ROC	Information about the Cost to Elect the Maximum Survivor Annuity	RI20-117_2021_02_ROC_Revised.pdf	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: OPM/Central-1

FR Citation: 75 FR 15013

Number of Respondents: 2,400

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,400	0	2,400
Annual IC Time Burden (Hours)	1,834	0	1,834
Annual IC Cost Burden (Dollars)	49,290	49,290	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.