DESIGNATION OF CHANGE OF BENEFICIARY FOR RESIDUAL LUMP SUM

ICR 198012-3220-020

OMB: 3220-0004

Federal Form Document

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ICR Details
3220-0004 198012-3220-020
Historical Active 198009-3220-014
RRB
DESIGNATION OF CHANGE OF BENEFICIARY FOR RESIDUAL LUMP SUM
No material or nonsubstantive change to a currently approved collection   No
Emergency 12/26/1980
Approved with change 12/26/1980
Retrieve Notice of Action (NOA) 12/26/1980
  Inventory as of this Action Requested Previously Approved
01/31/1981 01/31/1981 12/31/1980
3,000 0 3,000
500 0 500
0 0 0

UNDER SECTION 6(C)(1) OF THE RAILROAD RETIREMENT ACT, AND INDIVIDUAL MAY DESIGNATE A PERSON OR PERSONS WHOM THE INDIVIDUAL WISHES TO RECIEVE ANY DEATH LUMP BENEFITS PAYABLE UNDER THE ACT. THE DESIGNATION WILL OBTAIN INFORMATION ON THE PERSONS TO RECEIVE THE BENEFITS AND IN WHAT PROPORTION.

None
None


No

1
IC Title Form No. Form Name
DESIGNATION OF CHANGE OF BENEFICIARY FOR RESIDUAL LUMP SUM AA-11A

  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 3,000 3,000 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.
12/26/1980


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