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Federal forms, ICRs, and supporting documents

Information Collection Request

APPLICATION TO ELECT REDUCED ANNUITY WITH SURVIVOR BENEFIT FOR A FORMER SPOUSE, RI 20-41 (FORMERLY BRI46-423)

ICR 198610-3206-001 · OMB 3206-0163 · Historical Active

Forms and Documents
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IC Document Collections
IC IDCollectionTypeStatusForm
157000 APPLICATION TO ELECT REDUCED ANNUITY WITH SURVIVOR BENEFIT FOR A FORMER SPOUSE, RI 20-41 (FORMERLY BRI46-423) Form Migrated
ICR Details
3206-0163 198610-3206-001
Historical Active 198511-3206-002
OPM
APPLICATION TO ELECT REDUCED ANNUITY WITH SURVIVOR BENEFIT FOR A FORMER SPOUSE, RI 20-41 (FORMERLY BRI46-423)
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 11/05/1986
Retrieve Notice of Action (NOA) 10/03/1986
  Inventory as of this Action Requested Previously Approved
11/30/1988 11/30/1988
500 0 0
125 0 0
0 0 0
THIS FORM IS DESIGNED FOR USE BY ELIGIBLE ANNUITANTS TO ELECT TO PROVI A SURVIVOR ANNUITY BENEFIT FOR ELIGIBLE FORMER SPOUSES UNDER PUBLIC LAW 98-615 AS AMENDED BY PUBLIC LAW 99-551. THIS ELECTION MUST BE MAD WITHIN 12 MONTHS OF THE DATE SPECIFIED IN THE REGULATIONS.
None
None
No
1
IC Title Form No. Form Name
APPLICATION TO ELECT REDUCED ANNUITY WITH SURVIVOR BENEFIT FOR A FORMER SPOUSE, RI 20-41 (FORMERLY BRI46-423) BRI 46-423
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 500 0 0 0 500 0
Annual Time Burden (Hours) 125 0 0 0 125 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/03/1986