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Federal forms, ICRs, and supporting documents

Information Collection Request

DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION: INSTRUCTIONS, APPLICANT'S STATEMENT, PHYSICIAN'S STATEMENT

ICR 199103-3206-003 · OMB 3206-0133 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
176763 DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION: INSTRUCTIONS, APPLICANT'S STATEMENT, PHYSICIAN'S STATEMENT Form Migrated
ICR Details
3206-0133 199103-3206-003
Historical Active 199002-3206-002
OPM
DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION: INSTRUCTIONS, APPLICANT'S STATEMENT, PHYSICIAN'S STATEMENT
No material or nonsubstantive change to a currently approved collection   No
Emergency 03/12/1991
Approved with change 03/12/1991
Retrieve Notice of Action (NOA) 03/12/1991
  Inventory as of this Action Requested Previously Approved
03/31/1993 03/31/1993 03/31/1993
9,000 0 9,000
9,500 0 9,000
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.
None
None
No
1
IC Title Form No. Form Name
DOCUMENTATION IN SUPPORT OF DISABILITY RETIREMENT APPLICATION: INSTRUCTIONS, APPLICANT'S STATEMENT, PHYSICIAN'S STATEMENT SF 2824, 2824-A, 2824-C
  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 9,000 9,000 0 0 0 0
Annual Time Burden (Hours) 9,500 9,000 0 500 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
03/12/1991