Information Collection

Request to Disability Annuitant for Information on Physical Condition and Employment

IC 33615 under ICR 202403-3206-001 · OMB 3206-0143.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0143 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 30-1 Request to Disability Annuitant for Information on Physical Condition and Employment	Form and Instruction
Form RI 30-1 Request to Disability Annuitant for Information on Physical Condition and Employment	Form and Instruction
RI 30-1 Request to Disability Annuitant for Information on Physi RI30-001_2021_01_Markup.pdf www.opm.gov	Form and Instruction
RI 30-1 Request to Disability Annuitant for Information on Physi RI30-001_2021_01_Markup.pdf www.opm.gov	Form and Instruction
RI 30-1 Request to Disability Annuitant for Information on Physi RI30-001_2024_04_Revised.pdf www.opm.gov	Form and Instruction
RI 30-1 Request to Disability Annuitant for Information on Physi RI30-001_2024_04_Revised.pdf www.opm.gov	Form and Instruction

IC Title:

Request to Disability Annuitant for Information on Physical Condition and Employment

Agency IC Tracking Number:

RI 30-1

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 831.1206 through 831.1211 5 CFR 844.401 through 844.403 5 CFR 844.303 through 844.304

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 30-1	Request to Disability Annuitant for Information on Physical Condition and Employment	RI30-001_2021_01_Markup.pdf	www.opm.gov	Yes	No	Fillable Printable
Form and Instruction	RI 30-1	Request to Disability Annuitant for Information on Physical Condition and Employment	RI30-001_2024_04_Revised.pdf	www.opm.gov	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: OPM/Central-1

FR Citation: 75 FR 15013

Number of Respondents: 8,000

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	8,000	8,000
Annual IC Time Burden (Hours)	8,000	8,000
Annual IC Cost Burden (Dollars)	215,000	215,000

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.