OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84

ICR 202511-3206-005 · OMB 3206-0268 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form RI120-126 Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84 Form and Instruction Modified Available
Form RI120-126 Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84 Form and Instruction Modified Repair queued
RI20-126_OMBSupportingStmt_2025.docx Supporting Statement A Uploaded 2025-11-28 Repair queued
RI20-126_OMBSupportingStmt_2025.docx Supporting Statement A Uploaded 2025-11-28 Repair queued
E8-5659.pdf Supplementary Document Uploaded 2019-06-07 Available
E8-5659.pdf Supplementary Document Uploaded 2019-06-07 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
218495 Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84 Form and Instruction ModifiedCertification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84
218495 Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84 Form and Instruction Modified
ICR Details
3206-0268 202511-3206-005
Active 202211-3206-002
OPM RI 20-126
Certification of Qualifying District of Columbia Service Under Section 1905 of Public Law 111-84
Revision of a currently approved collection   No
Regular
Approved without change 02/26/2026
Retrieve Notice of Action (NOA) 11/28/2025
  Inventory as of this Action Requested Previously Approved
02/28/2029 36 Months From Approved 02/28/2026
1,000 0 1,000
500 0 500
18,010 0 13,437
RI 20-126 is used to certify that an employee performed certain service with the District of Columbia (DC) that qualifies under section 1905 of PL 111-84 for determining retirement eligibility. However, this service cannot be used in the computation of a retirement benefit.
PL: Pub.L. 111 - 84 1905 Name of Law: Certification of Qualifying DC Service Under Public Law 111-84 Sec 1905
  
None
Not associated with rulemaking
  90 FR 23383 06/02/2025
90 FR 54409 11/26/2025
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 1,000 1,000 0 0 0 0
Annual Time Burden (Hours) 500 500 0 0 0 0
Annual Cost Burden (Dollars) 18,010 13,437 0 4,573 0 0
No
No
$5,550
No
    Yes
    Yes
No
No
No
No
Alexys Stanley 202 606-1183 [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.
11/28/2025