OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Disabled Dependent Questionnaire

OMB 3206-0179 ยท OPM.

OMB 3206-0179

RI 30-10 collects sufficient information about the medical condition and earning capacity for OPM to determine whether a disabled adult child is eligible for health benefits coverage and/or survivor annuity payments under the Civil Service Retirement System or the Federal Employees Retirement System.

The latest form for Disabled Dependent Questionnaire expires 2021-06-30 and is listed under ICR 201802-3206-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form RI 30-10 Disabled Dependent QuestionnaireForm and Instruction
ARS PIA Final 12212017signed.pdf Supplementary Document
RI30-010_30DayFRNPublished_2021_06_25.pdf Supplementary Document
RI30-010_Published60DayFRN_2021_04_02.pdf Supplementary Document
RI30-010_OMBSupportingStmt_2021_05_12.docxSupporting Statement A
Disabled Dependent Questionnaire Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202106-3206-003 Revision of a currently approved collection 2021-06-29 Approved with change
201802-3206-001 Reinstatement with change of a previously approved collection 2018-02-22 Approved with change
201603-3206-010 No material or nonsubstantive change to a currently approved collection 2016-04-01 Approved without change
201408-3206-001 Extension without change of a currently approved collection 2014-08-19 Approved without change
201106-3206-010 Extension without change of a currently approved collection 2011-06-22 Approved without change
201005-3206-003 Revision of a currently approved collection 2010-05-04 Approved without change
200707-3206-003 Extension without change of a currently approved collection 2007-07-26 Approved without change
200406-3206-002 Revision of a currently approved collection 2004-06-30 Approved without change
200106-3206-001 Extension without change of a currently approved collection 2001-06-06 Approved without change
199804-3206-001 Reinstatement with change of a previously approved collection 1998-04-16 Approved without change
199406-3206-006 Revision of a currently approved collection 1994-06-16 Approved without change
199107-3206-003 Revision of a currently approved collection 1991-07-05 Approved without change
198804-3206-001 New collection (Request for a new OMB Control Number) 1988-04-18 Approved without change