Disabled Dependent Questionnaire

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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form RI 30-10 Disabled Dependent Questionnaire Form 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.docx Supporting Statement A
Disabled Dependent Questionnaire Form and Instruction

All Historical Document Collections

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