Information Collection

RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit

IC 194854 under ICR 202211-3206-004 · OMB 3206-0254.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0254 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 20-123 RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit	Form and Instruction
RI 20-123 Request for Case Review for Enhanced Disability Annuity RI 20-123_2020_01.pdf	Form and Instruction

IC Title:

RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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 and Instruction	RI 20-123	Request for Case Review for Enhanced Disability Annuity Benefit	RI 20-123_2020_01.pdf		No		Paper Only

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: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	100	0	100
Annual IC Time Burden (Hours)	8	0	8
Annual IC Cost Burden (Dollars)	225	225	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.