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Federal forms, ICRs, and supporting documents

Information Collection Request

SF 3112, CSRS/FERS Documentation in Support of Disability Retirement Application

ICR 201004-3206-011 · OMB 3206-0228 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form SF 3112 CSRS/FERS Documentation in Support of Disability Retirement Application Form and Instruction Modified Available
30-day FRN.pdf Supplementary Document Uploaded 2010-04-15 Available
60-day FRN.pdf Supplementary Document Uploaded 2010-04-15 Repair queued
SF 3112 SS.doc Supporting Statement A Uploaded 2010-04-15 Available
IC Document Collections
IC IDCollectionTypeStatusForm
33732 CSRS/FERS Documentation in Support of Disability Retirement Application Form and Instruction Modified
ICR Details
3206-0228 201004-3206-011
Historical Active 200704-3206-003
OPM
SF 3112, CSRS/FERS Documentation in Support of Disability Retirement Application
Revision of a currently approved collection   No
Regular
Approved without change 07/02/2010
Retrieve Notice of Action (NOA) 04/26/2010
  Inventory as of this Action Requested Previously Approved
07/31/2013 36 Months From Approved 07/31/2010
13,450 0 13,450
12,775 0 12,775
0 0 0
SF 3112 collects information from applicants for disability retirement so that OPM can determine whether to approve a disability retirement.
US Code: 5 USC Section 8451 Name of Law: Disability Retirement (FERS)
   US Code: 5 USC Section 8337 Name of Law: Disability Retirement (CSRS)
  
None
Not associated with rulemaking
  74 FR 58325 11/12/2009
75 FR 17787 04/07/2010
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 13,450 13,450 0 0 0 0
Annual Time Burden (Hours) 12,775 12,775 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$1,123,500
No
Yes
No
Uncollected
No
Uncollected
Miles Windsor 202 606-8358 [email protected]
  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.
04/26/2010