Forms Relating to Civilian Service Records

ICR 201512-3095-003

OMB: 3095-0037

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2015-12-23
IC Document Collections
ICR Details
3095-0037 201512-3095-003
Historical Active 201301-3095-001
NARA
Forms Relating to Civilian Service Records
Revision of a currently approved collection   No
Regular
Approved without change 02/22/2016
Retrieve Notice of Action (NOA) 12/23/2015
  Inventory as of this Action Requested Previously Approved
02/28/2019 36 Months From Approved 02/29/2016
20,800 0 32,060
1,733 0 2,671
0 0 0

Former Federal civilian employees and other authorized individuals use this information collection in order to obtain information from Official Personnel Folders or Employee Medical Folders.

None
None

Not associated with rulemaking

  80 FR 60182 10/05/2015
80 FR 79950 12/23/2015
No

1
IC Title Form No. Form Name
Forms Relating to Civilian Service Records NA Form 13022, NA Form 13064, NA Form 13068 Reply to Request Involving Relief Agencies ,   Returned Request ,   Walk-In Request for OPM Records or Information

  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 20,800 32,060 0 -11,260 0 0
Annual Time Burden (Hours) 1,733 2,671 0 -938 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
There was a decrease in the number of requests.

$0
No
No
No
No
No
Uncollected
Tamee Fechhelm 301-837-3204 tamee.fechhelm@nara.gov

  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.
12/23/2015


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