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Federal forms, ICRs, and supporting documents

Information Collection Request

Court Orders Affecting Retirement Benefits - 5 CFR 838.221, 838.421, and 838.721

ICR 200503-3206-004 · OMB 3206-0204 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
33695 Court Orders Affecting Retirement Benefits - 5 CFR 838.221, 838.421, and 838.721 Migrated
ICR Details
3206-0204 200503-3206-004
Historical Active 200203-3206-004
OPM
Court Orders Affecting Retirement Benefits - 5 CFR 838.221, 838.421, and 838.721
Extension without change of a currently approved collection   No
Regular
Approved without change 06/06/2005
Retrieve Notice of Action (NOA) 03/28/2005
  Inventory as of this Action Requested Previously Approved
06/30/2008 06/30/2008 06/30/2005
19,000 0 19,000
9,500 0 9,500
0 0 0
5 CFR 838.221, 838.421, and 838.721 require former spouses of Federal employees to write to OPM, providing specific information needed for OPM to make court-ordered benefit payments. This information is needed to identify affected employees and to certify that the court order remains in effect.
None
None
No
1
IC Title Form No. Form Name
Court Orders Affecting Retirement Benefits - 5 CFR 838.221, 838.421, and 838.721
  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 19,000 19,000 0 0 0 0
Annual Time Burden (Hours) 9,500 9,500 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.
03/28/2005