OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202009-3206-002 · OMB 3206-0162 · Received in OIRA

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 Repair queued
E8-5659.pdf Supplementary Document Uploaded 2020-09-17 Repair queued
OPM1530_2020_10_Revised.pdf Supplementary Document Uploaded 2020-09-17 Repair queued
OPM1530_2017_03_MarkUp.pdf Supplementary Document Uploaded 2020-09-17 Repair queued
2020-17685.pdf Supplementary Document Uploaded 2020-09-17 Repair queued
2020-07633.pdf Supplementary Document Uploaded 2020-09-17 Missing upstream
OPM1530_OMBSupportStmt_2020_09_28.docx Supporting Statement A Uploaded 2020-09-28 Repair queued
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 202009-3206-002
Received in OIRA 201703-3206-003
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 09/30/2020
  Requested Previously Approved
36 Months From Approved 01/31/2021
500 500
750 750
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. We have updated the display of OMB nomenclature and made editorial changes to the Privacy Act Statement.. 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
  85 FR 20532 04/13/2020
85 FR 49398 08/13/2020
No
  Total Request 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
    Yes
    Yes
No
No
No
No
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.
09/30/2020