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Federal forms, ICRs, and supporting documents

Information Collection Request

REPORT OF MEDICAL EXAMINATION OF PERSON ELECTING SURVIVOR BENEFIT UNDER THE CIVIL SERVICE RETIREMENT SYSTEM

ICR 199409-3206-001 · OMB 3206-0162 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
156998 REPORT OF MEDICAL EXAMINATION OF PERSON ELECTING SURVIVOR BENEFIT UNDER THE CIVIL SERVICE RETIREMENT SYSTEM Form Migrated
ICR Details
3206-0162 199409-3206-001
Historical Active 199112-3206-004
OPM
REPORT OF MEDICAL EXAMINATION OF PERSON ELECTING SURVIVOR BENEFIT UNDER THE CIVIL SERVICE RETIREMENT SYSTEM
Revision of a currently approved collection   No
Regular
Approved without change 12/23/1994
Retrieve Notice of Action (NOA) 09/27/1994
  Inventory as of this Action Requested Previously Approved
12/31/1997 12/31/1997 12/31/1994
500 0 1,000
750 0 1,500
0 0 0
PERSONS APPLYING FOR RETIREMENT UNDER THE CIVIL SERVICE RETIREMENT SYSTEM MAY ELECT AN INSURABLE INTEREST SURVIVOR ANNUITY IF THEY ARE IN GOOD HEALTH. OPM NEEDS MEDICAL EVIDENCE DEMONSTRATING THE CONDITION. OPM FORM 1530 IS DESIGNED TO COLLECT THIS INFORMATION AND GIVES THE PHYSICIAN PERMISSION TO RELEASE SUCH INFORMATION TO OPM.
None
None
No
1
IC Title Form No. Form Name
REPORT OF MEDICAL EXAMINATION OF PERSON ELECTING SURVIVOR BENEFIT UNDER THE CIVIL SERVICE RETIREMENT SYSTEM OPM 1530
  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 1,000 0 0 -500 0
Annual Time Burden (Hours) 750 1,500 0 0 -750 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.
09/27/1994