View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 3206-0262	ICR Reference No: 201305-3206-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: OPM	Agency Tracking No:
Title: Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/09/2013
	Date Received in OIRA: 11/05/2013
Terms of Clearance: OPM must report this collection as a violation in this year's Information Collection Budget.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	36 Months From Approved
Responses	5,400	0	0
Time Burden (Hours)	2,700	0	0
Cost Burden (Dollars)	0	0	0

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
OPM 1523	OPM 1523
SF 2812	SF 2812
SF 2812A	SF 2812A

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	5,400	5,400
Annual Time Burden (Hours)	2,700	2,700
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The increase in burden is due to OPM reporting the use of this previously unreported collection. Due to non-Federal entities participating in FERS, there is a potential for non-Federal employees at these organizations to have to complete these forms. The collections do not collect any PII. The vast majority of users of this collection are Federal.

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