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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.