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Federal forms, ICRs, and supporting documents

Information Collection Request

We Need Important Information About Your Eligibility for SSA Disability Benefits (Our Records Show That You Have Not Received A Decision From The SSA.)

ICR 199802-3206-005 · OMB 3206-0216 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
33717 We Need Important Information About Your Eligibility for SSA Disability Benefits (Our Records Show That You Have Not Received A Decision From The SSA.) Form Migrated
ICR Details
3206-0216 199802-3206-005
Historical Active 199403-3206-005
OPM
We Need Important Information About Your Eligibility for SSA Disability Benefits (Our Records Show That You Have Not Received A Decision From The SSA.)
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 04/03/1998
Retrieve Notice of Action (NOA) 02/11/1998
  Inventory as of this Action Requested Previously Approved
04/30/2001 04/30/2001
2,200 0 0
183 0 0
0 0 0
The information provided by the annuitant is used by OPM to verify receipt of SSA disability benefits, make necessary adjustments to the FERS disability benefit, and notify the annuitant of any overpayment payable to OPM. It also notifies the annuitant of the responsibility to notify OPM if SSA benefits begin and consequences of non-notification.
None
None
No
  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 2,200 0 0 2,200 0 0
Annual Time Burden (Hours) 183 0 0 183 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.
02/11/1998