This form will
be used only until OPM 1496B form is available for use.
Inventory as of this Action
Requested
Previously Approved
12/31/1985
12/31/1985
4,000
0
0
1,340
0
0
0
0
0
THE ADDENDUM COLLECTS INFORMATION
REGARDING EX-SPOUSES ELIGIBILITY FOR SURVIVOR BENEFITS IN CASES OF
DEFERRED RETIREMENTS UNDER THE CIVIL SERVICE RETIREMENT SYSTEM. THE
FORM WILL BE USED ONLY UNTIL OPM 1496B APPLICATION FOR DEFERRED
RETIREMENT FOR ANNUITIES COMMENCING ON OR AFT MAY 7, 1985, IS
AVAILABLE FOR USE.
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.