EMPLOYEE'S STATEMENT OF SERVICE PERFORMED BEFORE JAN. 1, 1937, TO EMPLOYERS UNDER THE RR ACT

ICR 198009-3220-010

OMB: 3220-0006

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
3220-0006 198009-3220-010
Historical Active 197508-3220-004
RRB
EMPLOYEE'S STATEMENT OF SERVICE PERFORMED BEFORE JAN. 1, 1937, TO EMPLOYERS UNDER THE RR ACT
No material or nonsubstantive change to a currently approved collection   No
Emergency 09/23/1980
Approved with change 09/23/1980
Retrieve Notice of Action (NOA) 09/23/1980
  Inventory as of this Action Requested Previously Approved
12/31/1980 12/31/1980 09/30/1980
2,000 0 2,000
500 0 500
0 0 0

RAILROAD SERVICE PRIOR TO 1937 CAN BE USED, UNDER CERTAIN CONDITIONS, FOR ENTITLEMENT TO AND AMOUNT OF ANNUITY PROVIDED FOR UNDER SECTION 2OF THE RAILROAD RETIREMENT ACT. SUCH SERVICE IS NOT CARRIED ON THE BOARD'S RECORDS. THE STATEMENT WILL OBTAIN THE APPLICANT'S CLAIM OF SUCH SERVICE. THE INFORMATION WILL BE USED FOR SECURING VERIFICATION

None
None


No

1
IC Title Form No. Form Name
EMPLOYEE'S STATEMENT OF SERVICE PERFORMED BEFORE JAN. 1, 1937, TO EMPLOYERS UNDER THE RR ACT AA-15

  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 2,000 2,000 0 0 0 0
Annual Time Burden (Hours) 500 500 0 0 0 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.
09/23/1980


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