Application for Senior Administrative Law Judge

Application for Senior Administrative Law Judge & Geographic Preference Statement for Senior Administrative Law Judge

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0248 can be found here:

Documents and Forms

Document Name Document Type
Form OPM 1655 Application for Senior Administrative Law Judge Form and Instruction
OPM 1655 Application for Senior Administrative Law Judge OPM Form 1655 - 2018.docx Form and Instruction
OPM 1655 w/changes OPM 1655 w/changes OPM Form 1655 with Track Changes.pdf Form and Instruction
OPM Form 1655 with Track Changes.pdf OPM Form 1655 with track changes IC Document

Information Collection (IC) Details

IC Title:	Application for Senior Administrative Law Judge	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 930.201

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	OPM 1655	Application for Senior Administrative Law Judge	OPM Form 1655 - 2018.docx		Yes	No	Fillable Printable
Form and Instruction	OPM 1655 w/changes	OPM 1655 w/changes	OPM Form 1655 with Track Changes.pdf		No		Fillable Printable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records
Title: OPM Central 6	FR Citation: 60 FR 63084

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	150	0	150
Annual IC Time Burden (Hours)	94	-6	100
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
OPM Form 1655 with track changes	OPM Form 1655 with Track Changes.pdf	06/25/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.