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Federal forms, ICRs, and supporting documents

Information Collection

Application for Court-Ordered Benefits for Former Spouses

IC 243243 under ICR 202008-3206-001 · OMB 3206-0275.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Application for Court-Ordered Benefits for Former Spouses SF 3119
 
No New
 
Voluntary
 
5 CFR 838, Sub-parts B, D and G  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Standard Form 3119 Application for Court-Ordered Benefits for Former Spouses SF3119_2020_11.pdf www.opm.gov Yes No Fillable Printable

General Government Central Personnel

OPM/Central 1  73 FR 15013

19,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 19,000 0 19,000 0 0 0
Annual IC Time Burden (Hours) 9,500 0 9,500 0 0 0
Annual IC Cost Burden (Dollars) 255,229 0 255,229 0 0 0

Title Document Date Uploaded
60 Day Federal Register Notice SF3119_60DayFRNPublished_2020_03_23.pdf 08/19/2020
30 Day Federal Register Notice 2020-15455.pdf 08/19/2020
Privacy Impact Assessment Annuity Roll System ARS PIA Final 12212017signed.pdf 08/19/2020
Systems of Records Notice E8-5659.pdf 08/19/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.