APPLICATION FOR CHILD'S INSURANCE ANNUITY FULL TIME STUDENT

ICR 197804-3220-002

OMB: 3220-0092

Federal Form Document

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Document
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IC Document Collections
ICR Details
3220-0092 197804-3220-002
Historical Active 197608-3220-004
RRB
APPLICATION FOR CHILD'S INSURANCE ANNUITY FULL TIME STUDENT
Revision of a currently approved collection   No
Regular
Approved without change 04/28/1978
Retrieve Notice of Action (NOA) 04/10/1978
  Inventory as of this Action Requested Previously Approved
04/30/1983 04/30/1983 10/31/1981
4,100 0 4,100
888 0 1,025
0 0 0

THE RAILROAD RETIREMENT ACT PROVIDES FOR PAYMENT OF AN ANNUITY TO CHILD OF A DECEASED RAILROAD WORKER WHO IS AGE 18 TO 22 AND IS A FULL-TIME STUDENT. THE APPLICATION WILL OBTAIN INFORMATION ABOUT THE APPLICANT AND THE DECEASED EMPLOYEE SUPPORTING A CLAIM FOR STUDENT'S BENEFITS. THE INFORMATION WILL BE USED FOR DETERMINING ENTITLEMENT TO AND AMOUNT OF ANNUITY APPLIED FOR.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR CHILD'S INSURANCE ANNUITY FULL TIME STUDENT AA-19S

  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 4,100 4,100 0 0 0 0
Annual Time Burden (Hours) 888 1,025 0 0 -137 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
04/10/1978


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