OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201703-3206-004 · 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 and Instruction Modified Repair queued
RI 20-123 FRN Published 2017-04136.pdf Supplementary Document Uploaded 2017-03-22 Repair queued
RI20-123_60DayFRN_Published_2016_06_22.pdf Supplementary Document Uploaded 2017-03-22 Available
RI 20-123_ SS_ Request for Case Review for Enhanced Disability Annuity Benefit 09_2016.doc Supporting Statement A Uploaded 2017-03-22 Available
IC Document Collections
IC IDCollectionTypeStatusForm
194854 RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit Form and Instruction Modified
ICR Details
3206-0254 201703-3206-004
Historical Active 201401-3206-004
OPM
RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit
Extension without change of a currently approved collection   No
Regular
Approved without change 10/02/2017
Retrieve Notice of Action (NOA) 03/30/2017
OPM must re-submit this form with a privacy act statement and provide the updated SORN and PIA upon renewal.
  Inventory as of this Action Requested Previously Approved
10/31/2019 36 Months From Approved 09/30/2017
100 0 100
8 0 8
0 0 0
Form RI 20-123, Request for Case Review for Enhanced Disability Annuity Benefit is available only on the OPM web site. 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
  81 FR 40731 06/22/2016
82 FR 12475 03/03/2017
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 100 100 0 0 0 0
Annual Time Burden (Hours) 8 8 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$5,550
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.
03/30/2017