OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

OPM 1530, Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System

ICR 201011-3206-006 · OMB 3206-0162 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form OPM 1530 Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System Form and Instruction Modified Available
60-day FRN.pdf Supplementary Document Uploaded 2010-11-29 Available
30-day FRN.pdf Supplementary Document Uploaded 2010-11-29 Repair queued
OPM 1530 SS.doc Supporting Statement A Uploaded 2010-11-29 Available
IC Document Collections
IC IDCollectionTypeStatusForm
33635 Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System Form and Instruction Modified
ICR Details
3206-0162 201011-3206-006
Historical Active 200712-3206-005
OPM
OPM 1530, 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 04/06/2011
Retrieve Notice of Action (NOA) 11/30/2010
  Inventory as of this Action Requested Previously Approved
04/30/2014 36 Months From Approved 04/30/2011
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 release such information to OPM.
US Code: 5 USC 8339(k)(I) Name of Law: Civil Service Retirement
  
None
Not associated with rulemaking
  75 FR 30868 06/02/2010
75 FR 70712 11/18/2010
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 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
$24,150
No
No
No
No
No
Uncollected
Phyllis Pinkney 202-606-0623 [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.
11/30/2010