Information Collection

Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System

IC 33635 under ICR 202402-3206-005 · OMB 3206-0162.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0162 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OPM 1530 Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System	Form and Instruction
OPM 1530 Report of Medical Examination of Person Electing Survivo OPM1530_2024_04.pdf www.opm.gov	Form and Instruction
OPM 1530 Report of Medical Examination of Person Electing Survivo OPM1530_2024_04.pdf www.opm.gov	Form and Instruction

IC Title:

Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System

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 831.613

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

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records

Title: OPM/Central-1

FR Citation: 73 FR 15013

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	6,719	6,719

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.