OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

CSRS/FERS Documentation in Support of Disability Retirement Application

ICR 202102-3206-004 · OMB 3206-0228 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form SF 3112 CSRS/FERS Documentation in Support of Disability Retirement Application Form and Instruction Modified Repair queued
2021-03964.pdf Supplementary Document Uploaded 2021-02-26 Repair queued
2020-11734.pdf Supplementary Document Uploaded 2021-02-26 Repair queued
SF3112_2018_02_MarkUp.pdf Supplementary Document Uploaded 2021-02-25 Repair queued
SF3112_2021_02_MarkUp.pdf Supplementary Document Uploaded 2021-02-25 Missing upstream
ARS PIA Final 12212017signed.pdf Supplementary Document Uploaded 2017-12-28 Repair queued
SF3112_Regs.pdf Supplementary Document Uploaded 2017-12-28 Repair queued
SF3112_OMBSupportingStmt_2021_02_18.docx Supporting Statement A Uploaded 2021-02-25 Available
IC Document Collections
IC IDCollectionTypeStatusForm
33732 CSRS/FERS Documentation in Support of Disability Retirement Application Form and Instruction Modified
ICR Details
3206-0228 202102-3206-004
Received in OIRA 201712-3206-009
OPM SF 3112
CSRS/FERS Documentation in Support of Disability Retirement Application
Revision of a currently approved collection   No
Regular 02/26/2021
  Requested Previously Approved
36 Months From Approved 02/28/2021
13,450 13,450
12,775 12,775
274,662 0
SF 3112 collects information from applicants for disability retirement so that OPM can determine whether to approve a disability retirement. The applicant will only complete Standard Forms 3112A and 3112C. Standard Forms 3112B, 3112D and 3112E will be completed by the immediate supervisor and the employing agency of the applicant.
US Code: 5 USC Section 8451 Name of Law: Disability Retirement (FERS)
   US Code: 5 USC Section 8337 Name of Law: Disability Retirement (CSRS)
  
None
Not associated with rulemaking
  85 FR 33205 06/01/2020
86 FR 11803 02/26/2021
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 13,450 13,450 0 0 0 0
Annual Time Burden (Hours) 12,775 12,775 0 0 0 0
Annual Cost Burden (Dollars) 274,662 0 0 274,662 0 0
No
No
$1,123,500
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.
02/26/2021