Information Collection

RI 38-117, Rollover Election

IC 33708 under ICR 202509-3206-001 · OMB 3206-0212.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI 38-17 RI 38-117, Rollover Election	Form and Instruction
Form RI 38-17 Rollover Election Form RI 38-117, Rollover Election	Form and Instruction
RI38-118_2025.pdf	Instruction
RI38-118_2025.pdf	Instruction
RI37-022_2025.pdf	Instruction
RI37-022_2025.pdf	Instruction
RI 38-17 Rollover Election Form RI38-117_2025.pdf	Form and Instruction
RI 38-17 Rollover Election Form RI38-117_2025.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form and Instruction	RI 38-17	No	Paper Only
Instruction		No	Paper Only
Instruction		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: 1,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,500	0	1,500
Annual IC Time Burden (Hours)	1,000	0	1,000
Annual IC Cost Burden (Dollars)	32,660	-27,589	60,249

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.

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