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Federal forms, ICRs, and supporting documents

Information Collection Request

Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System

ICR 200411-3206-001 · 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
33635 Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System Form Migrated
ICR Details
3206-0162 200411-3206-001
Historical Active 200107-3206-002
OPM
Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System
Revision of a currently approved collection   No
Regular
Approved without change 01/28/2005
Retrieve Notice of Action (NOA) 11/22/2004
  Inventory as of this Action Requested Previously Approved
01/31/2008 01/31/2008 01/31/2005
500 0 500
750 0 750
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 of good health. OPM Form 1530 collects this information and gives the physician permission to releast such information to OPM.
None
None
No
1
IC Title Form No. Form Name
Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System 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 500 500 0 0 0 0
Annual Time Burden (Hours) 750 750 0 0 0 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.
11/22/2004