CSRS/FERS Documentation in Support of Disability Retirement Application

ICR 202203-3206-012

OMB: 3206-0228

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Unchanged
Justification for No Material/Nonsubstantive Change
2022-03-08
Supplementary Document
2021-02-26
Supplementary Document
2021-02-26
Supplementary Document
2021-02-25
Supplementary Document
2021-02-25
Supplementary Document
2017-12-28
Supplementary Document
2017-12-28
Supporting Statement A
2021-02-25
IC Document Collections
ICR Details
3206-0228 202203-3206-012
Received in OIRA 202102-3206-004
OPM SF 3112
CSRS/FERS Documentation in Support of Disability Retirement Application
No material or nonsubstantive change to a currently approved collection   No
Regular 03/08/2022
  Requested Previously Approved
03/31/2024 03/31/2024
13,450 13,450
12,775 12,775
274,662 274,662

SF 3112 collects information from applicants for disability retirement so that OPM can determine whether to approve a disability retirement. The applicant will only complete Standard Forms 3112A and 3112C. Standard Forms 3112B, 3112D and 3112E will be completed by the immediate supervisor and the employing agency of the applicant.

US Code: 5 USC Section 8451 Name of Law: Disability Retirement (FERS)
   US Code: 5 USC Section 8337 Name of Law: Disability Retirement (CSRS)
  
None

Not associated with rulemaking

  85 FR 33205 06/01/2020
86 FR 11803 02/26/2021
No

  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 13,450 13,450 0 0 0 0
Annual Time Burden (Hours) 12,775 12,775 0 0 0 0
Annual Cost Burden (Dollars) 274,662 274,662 0 0 0 0
No
No

$1,123,500
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.
03/08/2022


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