Information Collection

Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84

IC 218495 under ICR 202511-3206-005 · OMB 3206-0268.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RI120-126 Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84	Form and Instruction
Form RI120-126 Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84 Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84	Form and Instruction
RI120-126 Certification of Qualifying District of Columbia Service RI20-126_2024_03.pdf	Form and Instruction
RI120-126 Certification of Qualifying District of Columbia Service RI20-126_2024_03.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.1

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	RI120-126			opm.gov	Yes	No	Printable Only

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records

Title: OPM/ Central-1

FR Citation: 73 FR 1503

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,000	0	1,000
Annual IC Time Burden (Hours)	500	0	500
Annual IC Cost Burden (Dollars)	18,010	4,573	13,437

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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