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

Forms and Documents

Document Name	Status
Form OPM 1496A Application for Deferred Retirement (Separations on or after October 1, 1956) Form and Instruction	Modified
OPM1496A_30DayFRN_2021_05_26.pdf Supplementary Document	2021-06-23
OPM1496A_60dayFRN_2020_12_30.pdf Supplementary Document	2021-06-23
FACES 2017 FINAL 12212017signed.pdf Supplementary Document	2018-03-20
ARS PIA Final 12212017signed.pdf Supplementary Document	2018-03-20
OPM 1496A Regulations.pdf Supplementary Document	2018-03-20
OPM1496A_OMBSupportingStmt_2021_03_05.docx Supporting Statement A	2021-06-23

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: 202106-3206-002
Status: Received in OIRA	Previous ICR Reference No: 201803-3206-004
Agency/Subagency: OPM	Agency Tracking No: OPM 1496A
Title: Application for Deferred Retirement (Separations on or after October 1, 1956); OPM 1496A
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/29/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2021
Responses	2,800	2,800
Time Burden (Hours)	2,800	2,800
Cost Burden (Dollars)	75,250	0

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Abstract: OPM 1496A is used by eligible former Federal employees to apply for Civil Service annuity.

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Authorizing Statute(s): US Code: 5 USC 83 Name of Law: Civil Service Retirement
   US Code: 5 USC 8338 Name of Law: Deferred 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:
	85 FR 86583	12/30/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 28397	05/26/2021
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	You May Be Eligible for Deferred Retirement

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ICR Summary of Burden

	Total Request	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)	75,250	0	0	75,250	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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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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: 06/29/2021

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