OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Disabled Dependent Questionnaire

OMB 3206-0179 · OPM.

OMB 3206-0179

RI 30-10 collects sufficient information about the medical condition and earning capacity for OPM to determine whether a disabled adult child is eligible for health benefits coverage and/or survivor annuity payments under the Civil Service Retirement System or the Federal Employees Retirement System.

The latest form for Disabled Dependent Questionnaire expires 2021-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form and Instruction
Supplementary Document
Supplementary Document
Supplementary Document
Supporting Statement A
All Historical Document Collections
Approved with change
 Revision of a currently approved collection 2021-06-29
Approved with change
 Reinstatement with change of a previously approved collection 2018-02-22
Approved without change
 No material or nonsubstantive change to a currently approved collection 2016-04-01
Approved without change
 Extension without change of a currently approved collection 2014-08-19
Approved without change
 Extension without change of a currently approved collection 2011-06-22
Approved without change
 Revision of a currently approved collection 2010-05-04
Approved without change
 Extension without change of a currently approved collection 2007-07-26
Approved without change
 Revision of a currently approved collection 2004-06-30
Approved without change
 Extension without change of a currently approved collection 2001-06-06
Approved without change
 Reinstatement with change of a previously approved collection 1998-04-16
Approved without change
 Revision of a currently approved collection 1994-06-16
Approved without change
 Revision of a currently approved collection 1991-07-05
Approved without change
 New collection (Request for a new OMB Control Number) 1988-04-18