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OMB Control No: 3206-0212	ICR Reference No: 202509-3206-001
Status: Received in OIRA	Previous ICR Reference No: 202207-3206-004
Agency/Subagency: OPM	Agency Tracking No: RI 38-117, RI 37-118 and RI 37-22
Title: RI 38-117, Rollover Election, RI 37-118, Rollover Information, and RI 37-22, Special Tax Notice Regarding Rollovers
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 09/26/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2025
Responses	1,500	1,500
Time Burden (Hours)	1,000	1,000
Cost Burden (Dollars)	32,660	60,249

Authorizing Statute(s): PL: Pub.L. 107 - 16 643 Name of Law: Rollovers of after-tax contributions
   PL: Pub.L. 107 - 16 641 Name of Law: Rollovers allowed among various types of plans
   US Code: 26 USC 402(f) and 402(c)(2) Name of Law: Taxability of beneficiary of employees' trust
   US Code: 5 USC 8432(j)(2) Name of Law: Lump-sum benefits; designation of beneficiary; order of precedence
   PL: Pub.L. 107 - 147 411 Name of Law: Amendments related to Economic Growth and Tax Relief Reconciliation Act of 2001

Citations for New Statutory Requirements: None

Annual Cost to Federal Government: $8,500

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

Agency Contact: Alexys Stanley 202 606-1183 alexys.stanley@opm.gov