Information Collection

Form 12311 - Repayment of a Federal Government Buyout and Possible Suspension of Severance Pay

IC 19621 under ICR 202110-1545-016 · OMB 1545-1920.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1920 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 12311 Form 12311 - Repayment of a Federal Government Buyout and Possible Suspension of Severance Pay	Form
12311 Repayment of a Federal Government Buyout and Possible Su Form 12311--2005-11-00.pdf	Form
12311 Repayment of a Federal Government Buyout and Possible Su Form 12311--2005-11-00.pdf	Form

IC Title:

Form 12311 - Repayment of a Federal Government Buyout and Possible Suspension of Severance Pay

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 550.771 5 CFR 550.710

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	12311	Repayment of a Federal Government Buyout and Possible Suspension of Severance Pay	Form 12311--2005-11-00.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,624

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	Previously Approved
Annual Number of Responses for this IC	6,624	6,624
Annual IC Time Burden (Hours)	530	530
Annual IC Cost Burden (Dollars)	0	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.