Annuity Supplement Earnings Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form RI 92-22 Annuity Supplement Earning Report	Form and Instruction	Modified	Available
Form RI92-022 Annuity Supplement Earnings Report	Form and Instruction	Modified	Available
Form RI92-022 Annuity Supplement Earnings Report	Form and Instruction	Modified	Available
RI92-022_Justification_2025.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-12-17	Available
RI92-022_Justification_2025.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-12-17	Repair queued
RI92-022_OMBSupportingStmt_2024_03_21.docx	Supporting Statement A	Uploaded 2024-05-01	Available
RI92-022_OMBSupportingStmt_2024_03_21.docx	Supporting Statement A	Uploaded 2024-05-01	Available
RI92-022_Citations.pdf	Supplementary Document	Uploaded 2022-02-07	Available
RI92-022_Citations.pdf	Supplementary Document	Uploaded 2022-02-07	Repair queued
E8-5659.pdf	Supplementary Document	Uploaded 2022-02-07	Repair queued
E8-5659.pdf	Supplementary Document	Uploaded 2022-02-07	Repair queued
ARS PIA Final 12212017signed.pdf	Supplementary Document	Uploaded 2022-02-07	Available
ARS PIA Final 12212017signed.pdf	Supplementary Document	Uploaded 2022-02-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33678	Annuity Supplement Earnings Report	Form and Instruction	Modified	Annuity Supplement Earning Report
33678	Annuity Supplement Earnings Report	Form and Instruction	Modified	Annuity Supplement Earnings Report
33678	Annuity Supplement Earnings Report	Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0194	ICR Reference No: 202511-3206-001
Status: Active	Previous ICR Reference No: 202404-3206-011
Agency/Subagency: OPM	Agency Tracking No: RI 92-22
Title: Annuity Supplement Earnings Report
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: Approved with change	Conclusion Date: 02/26/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/17/2025
Terms of Clearance: This collection is approved based on the revised materials provided by the Agency.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2026	06/30/2026	06/30/2026
Responses	13,000	0	13,000
Time Burden (Hours)	3,250	0	3,250
Cost Burden (Dollars)	75,075	0	75,075

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Abstract: RI 92-22, Annuity Supplement Earnings Report, is used each year to obtain the earned income of Federal Employees Retirement System (FERS) annuitants receiving an annuity supplement. The annuity supplement is paid to eligible FERS annuitants who are not retired on disability and are not yet age 62. The supplement approximates the portion of a full career Social Security benefit earned while under FERS and ends at age 62. Like Social Security benefits, the annuity supplement is subject to an earnings limitation.

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Authorizing Statute(s): US Code: 5 USC Chapter 84, Section 8421 Name of Law: FERS, Annuity Supplement
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 60991	09/06/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 34288	04/30/2024
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Annuity Supplement Earnings Report	RI92-022, RI 92-22	Annuity Supplement Earnings Report ,   Annuity Supplement Earning Report

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	13,000	13,000	0	0	0	0
Annual Time Burden (Hours)	3,250	3,250	0	0	0	0
Annual Cost Burden (Dollars)	75,075	75,075	0	0	0	0

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:

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Annual Cost to Federal Government: $45,550

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

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Common Form ICR:  No

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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: 12/17/2025

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