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

OMB 3206-0268

RI 20-126 is used to certify that an employee performed certain service with the District of Columbia (DC) that qualifies under section 1905 of PL 111-84 for determining retirement eligibility. However, this service cannot be used in the computation of a retirement benefit.The revision date is needed for inventory control of previously obsolete forms. The Privacy Act Statement has been updated due to a generic systematic review by our Chief Privacy Officer.

The latest form for Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84 expires 2022-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form RI 20-126 Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84 Form and Instruction
E8-5659.pdf Supplementary Document
RI20-126_OMBSupptStmt_2022_08_09.docx Supporting Statement A
Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84 Form and Instruction

All Historical Document Collections

202211-3206-002 Approved with change	Reinstatement without change of a previously approved collection	2023-02-03
201905-3206-003 Approved with change	Reinstatement with change of a previously approved collection	2019-06-10
201510-3206-005 Approved with change	New collection (Request for a new OMB Control Number)	2015-10-29