This request is approved with a condition that OPM will: 1. In accordance with 5CFR1320.21 include a burden disclosure notice on the form "Applicant's Statement of Disability." This form is clearly covered by the burden disclosure requirement since it is sometimes used to collect information from individuals who have been seperated from Federal employment. 2. Prior to printing this form OPM will develop an estimate of the burden associated with it and reassess the burden currently stated as one hour associated with the physician's statement. OPM is to submit the changed burden extimates to OMB using an inventory correction worksheet.
Inventory as of this Action
Requested
Previously Approved
03/31/1993
03/31/1993
04/30/1990
9,000
0
10,000
9,000
0
10,000
0
0
0
STANDARD FORM 2814, DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION, PROVIDES INFORMATION, INSTRUCTIONS, AND MEANS FOR AN EMPLOYEE TO APPLY FOR DISABILITY RETIREMENT. SF 2824 A IS THE APPLICANT'S STATEMENT, SF 2824 B, SF2824 D, AND SF 2824 E ARE COMPLETE BY THE AGENCY. SF 2824 C IS COMPLETED BY THE EMPLOYEE'S PHYSICIAN.
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.
DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION (SF 2824) PHYSICIAN'S STATEMENT (SF 2824, SCHEDULE C)