Information Collection

Request to Disability Annuitant for Information on Physical Condition and Employment

IC 33615 under ICR 201606-3206-005 · OMB 3206-0143.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0143 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Request to Disability Annuitant for Information on Physical Condition and Employment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 831.1206 through 831.1211 5 CFR 844.303 through 844.304 5 CFR 844.401 through 844.403

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title: OPM/Central-1	FR Citation: 75 FR 15013

Number of Respondents: 8,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	8,000	8,000
Annual IC Time Burden (Hours)	8,000	8,000
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.