OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit

ICR 201010-3206-005 · OMB 3206-0254 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form RI 20-123 RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit Form New Repair queued
Background_RI20-123.doc Supplementary Document Uploaded 2010-10-14 Available
60-day FRN.pdf Supplementary Document Uploaded 2010-10-14 Available
RI 20-123 30-day FRN.pdf Supplementary Document Uploaded 2010-10-14 Available
RI 20-123 SS.doc Supporting Statement A Uploaded 2010-10-14 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
194854 RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit Form New
ICR Details
3206-0254 201010-3206-005
Historical Active
OPM
RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 03/17/2011
Retrieve Notice of Action (NOA) 11/02/2010
  Inventory as of this Action Requested Previously Approved
03/31/2014 36 Months From Approved
720 0 0
60 0 0
0 0 0
Form RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit is available only on the OPM website. It is used by retirees separated for disability and the survivors of retirees separated for disability to request that Retirement Operations review the computations of disability annuities to include the formulae provided in law for individuals who performed service as law enforcement officers, firefighters, nuclear materials carriers, air traffic controllers, Congressional employees, and Capitol and Supreme Court police.
US Code: 5 USC 8337 Name of Law: Disability Retirement (CSRS)
   US Code: 5 USC 8339 Name of Law: Computation of Annuity (CSRS)
   US Code: 5 USC 8452 Name of Law: Computation of disability annuity (FERS)
  
None
Not associated with rulemaking
  75 FR 30867 06/02/2010
75 FR 61784 10/06/2010
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 720 0 0 720 0 0
Annual Time Burden (Hours) 60 0 0 60 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new collection. The annual usage is expected to decrease in the future because the pool of persons affected is finite and they will only use this form once.
$5,550
No
No
No
No
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.
11/02/2010