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 201703-3206-003 · OMB 3206-0162 · 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
OPM1530_30DayFRN_Published_2017_05_05.pdf Supplementary Document Uploaded 2017-05-12 Available
OPM 1530 March 2017_Mark up copy.pdf Supplementary Document Uploaded 2017-03-30 Available
OPM 1530_ revised _2011.pdf Supplementary Document Uploaded 2017-03-30 Available
OPM 1530 60 Day FRN_8 _10_2016.pdf Supplementary Document Uploaded 2017-03-22 Repair queued
OPM1530_OMBSupportStmt_2017_04_11.doc Supporting Statement A Uploaded 2017-05-12 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 201703-3206-003
Active 201402-3206-006
OPM
OPM 1530, Report of Medical Examination of Person Electing Survivor Benefits Under the Civil Service Retirement System
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 10/02/2017
Retrieve Notice of Action (NOA) 05/15/2017
OPM should review the privacy act statement on the form before it it next submitted for OMB review. In addition, please provide the most recent PIA and SORN with the renewal materials. This collection should be reported in the information collection budget.
  Inventory as of this Action Requested Previously Approved
10/31/2020 6 Months From Approved
500 0 0
750 0 0
0 0 0
OPM Form 1530 is designed to collect information from both the applicant and the applicant’s physician regarding the applicant’s health. This information is used to determine whether the insurable interest survivor benefits election can be allowed. The form has been revised to bring it up-to-date. Specifically, solicitation of this information is also authorized by the Federal Employees Retirement System (Chapter 84, title 5, United States Code).
US Code: 5 USC 8339(k)(I) Name of Law: Civil Service Retirement
   US Code: 5 USC 84 Name of Law: Federal Employees Retirement
  
None
Not associated with rulemaking
  81 FR 52915 08/10/2016
82 FR 21274 05/05/2017
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 0 0 0 0 500
Annual Time Burden (Hours) 750 0 0 0 0 750
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$24,150
No
    Yes
    Yes
No
No
No
Uncollected
Charles Conyers 202 606-0125 [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.
05/15/2017