OPM 1496A, Application for Deferred Retirement (Separations on or after October 1, 1956)

Forms and Documents

Document Name	Status
Form OPM 1496A Application for Deferred Retirement (Separations on or after October 1, 1956) Form and Instruction	Modified
60-Day FRN.pdf Supplementary Document	2014-12-29
30-Day FRN.pdf Supplementary Document	2014-12-29
OPM 1496A March 2015 Markup.pdf Supplementary Document	2014-12-29
OPM 1496A August 2012 Markup.pdf Supplementary Document	2014-12-29
OPM 1496A Supporting Statement.doc Supporting Statement A	2014-12-29

IC Document Collections

IC ID	Document Title	Status
33585	Application for Deferred Retirement (Separations on or after October 1, 1956) Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0121	ICR Reference No: 201412-3206-005
Status: Historical Active	Previous ICR Reference No: 201112-3206-002
Agency/Subagency: OPM	Agency Tracking No:
Title: OPM 1496A, Application for Deferred Retirement (Separations on or after October 1, 1956)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/27/2015
	Date Received in OIRA: 01/26/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved	04/30/2015
Responses	2,800	0	2,800
Time Burden (Hours)	2,800	0	2,800
Cost Burden (Dollars)	0	0	0

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Abstract: OPM 1496A is used by eligible former Federal employees to apply for Civil Service annuity. The OPM 1496 is being removed because there are less than 10 respondents per year. A request to provide a marriage certificate was added. In addition, minor revisions are included to update the form.

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Authorizing Statute(s): US Code: 5 USC 8338 Name of Law: Deferred Retirement
   US Code: 5 USC 83 Name of Law: Civil Service Retirement
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 41603	07/16/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 76408	12/22/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for Deferred Retirement (Separations on or after October 1, 1956)	OPM 1496A	Application for Deferred Retirement (For persons separated on or after October 1, 1956)

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ICR Summary of Burden

	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	2,800	2,800	0	0	0	0
Annual Time Burden (Hours)	2,800	2,800	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $323,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 01/26/2015

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