Annuity Supplement Earnings Report

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form RI 92-22 Annuity Supplement Earnings Report Form and Instruction
RI 92-22 Annuity Supplement Earnings Report_MarkUp RI92-022_2019_03_MarkUp.pdf www.opm.gov Form and Instruction
RI 92-22 Annuity Supplement Earnings Report_MarkUp RI92-022_2019_03_MarkUp.pdf www.opm.gov Form and Instruction
RI 92-22 Annuity Supplement Earnings Report RI92-022_2022_03_Proof06_2022_02_07.pdf www.opm.gov Form and Instruction
RI 92-22 Annuity Supplement Earnings Report RI92-022_2022_03_Proof06_2022_02_07.pdf www.opm.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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 842.504 5 CFR 842.505

Information Collection 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_MarkUp	RI92-022_2019_03_MarkUp.pdf	www.opm.gov	Yes	No	Fillable Printable
Form and Instruction	RI 92-22	Annuity Supplement Earnings Report	RI92-022_2022_03_Proof06_2022_02_07.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 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	13,000	0	0	13,000
Annual IC Time Burden (Hours)	3,250	0	0	3,250
Annual IC Cost Burden (Dollars)	87,282	-87,262	87,262	87,282

Documents for IC

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.