Application for Deferred Retirement (Separations on or after October 1, 1956); OPM 1496A

ICR 202106-3206-002

OMB: 3206-0121

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2021-06-23
Supplementary Document
2021-06-23
Supplementary Document
2018-03-20
Supplementary Document
2018-03-20
Supplementary Document
2018-03-20
Supporting Statement A
2021-06-23
ICR Details
3206-0121 202106-3206-002
Received in OIRA 201803-3206-004
OPM OPM 1496A
Application for Deferred Retirement (Separations on or after October 1, 1956); OPM 1496A
Revision of a currently approved collection   No
Regular 06/29/2021
  Requested Previously Approved
36 Months From Approved 06/30/2021
2,800 2,800
2,800 2,800
75,250 0

OPM 1496A is used by eligible former Federal employees to apply for Civil Service annuity.

US Code: 5 USC 83 Name of Law: Civil Service Retirement
   US Code: 5 USC 8338 Name of Law: Deferred Retirement
  
None

Not associated with rulemaking

  85 FR 86583 12/30/2020
86 FR 28397 05/26/2021
No

1
IC Title Form No. Form Name
Application for Deferred Retirement (Separations on or after October 1, 1956) OPM 1496A You May Be Eligible for Deferred Retirement

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,800 2,800 0 0 0 0
Annual Time Burden (Hours) 2,800 2,800 0 0 0 0
Annual Cost Burden (Dollars) 75,250 0 0 75,250 0 0
No
No

$323,000
No
    Yes
    Yes
No
No
No
No
Charles Conyers 202 606-0125 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/29/2021


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