RI 38-117, Rollover Election, RI 37-118, Rollover Information, and RI 37-22, Special Tax Notice Regarding Rollovers

OMB 3206-0212

RI 38-117, Rollover Election, is used to collect information from each payee affected by a change in the tax code so that OPM can make payment in accordance with the wishes of the payee. RI 38-118, Rollover Information, explains the election. RI 37-22, Special Tax Notice Regarding Rollovers, provides more detailed information. Privacy Act Statements have been added to RI 38--117 and RI 37-22.The Privacy Act Statement for RI 38--117 has been revised due to a general systematic review by our Chief Privacy Officer.

The latest form for RI 38-117, Rollover Election, RI 37-118, Rollover Information, and RI 37-22, Special Tax Notice Regarding Rollovers expires 2022-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form RI 38-117 RI 38-117, Rollover Election Form and Instruction
E8-5659.pdf Supplementary Document
OMB RI 38-117 2022 Supporting Statement_Revised.docx Supporting Statement A
RI 38-117 _Published30DayFRN_2022_07_27.pdf Supplementary Document
RI38-117_RI38-118_RI37-22_60DAYFRNPublished_2022_01_12.pdf Supplementary Document
RI 38-117, Rollover Election Form and Instruction

All Historical Document Collections

202207-3206-004 Approved without change	Extension without change of a currently approved collection	2022-07-27
201904-3206-001 Approved without change	Revision of a currently approved collection	2019-05-30
201510-3206-003 Approved without change	Revision of a currently approved collection	2015-10-29
201211-3206-003 Approved without change	Extension without change of a currently approved collection	2012-11-06
201008-3206-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2010-08-24
200911-3206-005 Approved with change	Revision of a currently approved collection	2009-11-06
200810-3206-008 Approved with change	No material or nonsubstantive change to a currently approved collection	2008-10-29
200605-3206-002 Approved without change	Revision of a currently approved collection	2006-05-17
200303-3206-002 Approved without change	Revision of a currently approved collection	2003-03-21
200106-3206-002 Approved without change	Reinstatement with change of a previously approved collection	2001-06-06
199712-3206-001 Approved without change	Reinstatement with change of a previously approved collection	1997-12-05
199405-3206-003 Approved without change	Revision of a currently approved collection	1994-05-24
199303-3206-002 Approved without change	New collection (Request for a new OMB Control Number)	1993-03-12