Application for Refund of Retirement Deductions (FERS)/Current-Former Spouse's Notification of Application for Refund of Retirement Deductions Under the....

Forms and Documents

Document Name	Status
Form SF 3106/3106A Application for Refund of Retirement Deductions/Federal Employees Retirement System (SF 3106) Current/Former Spouse's Notification of Application for Refund of Retirement Deductions Under the.... Form and Instruction	Unchanged
OMB_Justification_SF3106_2022_03_08.docx Justification for No Material/Nonsubstantive Change	2022-03-08
SF3106_3106A_30DayFRNPublished_2021_06_28.pdf Supplementary Document	2021-06-29
2020-28900.pdf Supplementary Document	2021-06-29
FACES 2017 FINAL 12212017signed.pdf Supplementary Document	2017-12-29
ARS PIA Final 12212017signed.pdf Supplementary Document	2017-12-29
SF 3106 citations.pdf Supplementary Document	2017-12-29
SF3106_SF3106A_OMBSupportingStmt_2021_08_31.docx Supporting Statement A	2021-08-31

IC Document Collections

IC ID	Document Title	Status
33648	Application for Refund of Retirement Deductions/Federal Employees Retirement System (SF 3106) Current/Former Spouse's Notification of Application for Refund of Retirement Deductions Under the.... Form and Instruction	Unchanged

ICR Details

OMB Control No: 3206-0170	ICR Reference No: 202203-3206-010
Status: Received in OIRA	Previous ICR Reference No: 202106-3206-010
Agency/Subagency: OPM	Agency Tracking No: SF 3106/SF 3106A
Title: Application for Refund of Retirement Deductions (FERS)/Current-Former Spouse's Notification of Application for Refund of Retirement Deductions Under the....
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/08/2022

	Requested	Previously Approved
Expiration Date	09/30/2024	09/30/2024
Responses	14,400	14,400
Time Burden (Hours)	4,533	4,533
Cost Burden (Dollars)	121,900	121,900

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Abstract: SF 3106 is used by former Federal employees under the Federal Employees Retirement System, to apply for a refund of retirement deductions withheld during Federal employment, plus any interest provided by law. SF 3106A is used by refund applicants to notify their current/former spouse(s) that they are applying for a refund of retirement deductions, which is required by law.

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Authorizing Statute(s): US Code: 5 USC Chapter 84 Name of Law: Federal Employees Retirement System
   PL: Pub.L. 111 - 84 Title XIX Name of Law: Federal Employee Benefits
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 86583	12/30/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 34060	06/28/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for Refund of Retirement Deductions/Federal Employees Retirement System (SF 3106) Current/Former Spouse's Notification of Application for Refund of Retirement Deductions Under the....	SF 3106/3106A, SF 3106/3106A	Application for Refund of Retirement Deductions/Current and Former Spouses Notification of... ,   Application for Refund of Retirement Deductions/Current and Former Spouses Notification of...

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ICR Summary of Burden

	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	14,400	14,400	0	0	0	0
Annual Time Burden (Hours)	4,533	4,533	0	0	0	0
Annual Cost Burden (Dollars)	121,900	121,900	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $136,512

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/08/2022

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