REQUEST FOR COURT STATEMENT REGARDING DIVORCE OR ANNULMENT

ICR 197909-3220-012

OMB: 3220-0065

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3220-0065 197909-3220-012
Historical Active 197907-3220-026
RRB
REQUEST FOR COURT STATEMENT REGARDING DIVORCE OR ANNULMENT
Revision of a currently approved collection   No
Regular
Approved without change 12/28/1979
Retrieve Notice of Action (NOA) 09/28/1979
  Inventory as of this Action Requested Previously Approved
12/31/1980 12/31/1980 12/31/1979
250 0 500
21 0 42
0 0 0

SECTION 2 OF THE RAILROAD RETIREMENT ACT PROVIDES FOR PAYMENT OF ANNUITIES TO SPOUSES OF EMPLOYEES ANNUITANTS AND WIDOW(ER)S OF DECEASED RAILROAD EMPLOYEES. THE STATEMENT WILL OBTAIN INFORMATION ABOUT THE TERMINATION OF A FORMER MARRIAGE WHEN EITHER PARTNER HAD ONE OR MORE MARRIAGES. THE INFORMATION ON THE STATEMENT WILL BE USED FOR DETERMINING ENTITLEMENT TO BENEFITS.

None
None


No

1
IC Title Form No. Form Name
REQUEST FOR COURT STATEMENT REGARDING DIVORCE OR ANNULMENT G-238A

  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 250 500 0 0 -250 0
Annual Time Burden (Hours) 21 42 0 0 -21 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.
09/28/1979


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