Application for Deferred Retirement (Separations on or after October 1, 1956); OPM 1496A

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OPM 1496A You May Be Eligible for Deferred Retirement	Form and Instruction	Modified	Available
Form OPM 1496A_Revised You May Be Eligible for Deferred Retirement	Form and Instruction	Modified	Available
Form OPM 1496A_Revised Application for Deferred Retirement (Separations on or after October 1, 1956)	Form and Instruction	Modified	Repair queued
OPM1496A_Justification.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-12-12	Available
OPM1496A_Justification.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-12-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33585	Application for Deferred Retirement (Separations on or after October 1, 1956)	Form and Instruction	Modified	You May Be Eligible for Deferred Retirement
33585	Application for Deferred Retirement (Separations on or after October 1, 1956)	Form and Instruction	Modified	You May Be Eligible for Deferred Retirement
33585	Application for Deferred Retirement (Separations on or after October 1, 1956)	Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0121	ICR Reference No: 202212-3206-002
Status: Historical Inactive	Previous ICR Reference No: 202106-3206-002
Agency/Subagency: OPM	Agency Tracking No: OPM 1496A
Title: Application for Deferred Retirement (Separations on or after October 1, 1956); OPM 1496A
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 12/14/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/13/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	08/31/2024	08/31/2024
Responses	2,800	0	2,800
Time Burden (Hours)	2,800	0	2,800
Cost Burden (Dollars)	75,250	0	75,250

---

Abstract: OPM 1496A is used by eligible former Federal employees to apply for Civil Service annuity.

---

Authorizing Statute(s): US Code: 5 USC 8338 Name of Law: Deferred Retirement
   US Code: 5 USC 83 Name of Law: Civil Service Retirement
  

Citations for New Statutory Requirements: None

---

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

---

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 28397	05/26/2021
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Application for Deferred Retirement (Separations on or after October 1, 1956)	OPM 1496A, OPM 1496A_Revised	You May Be Eligible for Deferred Retirement ,   You May Be Eligible for Deferred Retirement

---

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:

---

Annual Cost to Federal Government: $323,000

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

---

Common Form ICR:  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:

(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: 12/13/2022

---