APPLICATION TO ACT AS REPRESENTATIVE PAYEE

ICR 198103-3220-001

OMB: 3220-0052

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
157452 Migrated
ICR Details
3220-0052 198103-3220-001
Historical Active 198003-3220-004
RRB
APPLICATION TO ACT AS REPRESENTATIVE PAYEE
Revision of a currently approved collection   No
Regular
Approved without change 04/29/1981
Retrieve Notice of Action (NOA) 03/04/1981
  Inventory as of this Action Requested Previously Approved
04/30/1982 04/30/1982 03/31/1981
14,000 0 3,000
14,667 0 500
0 0 0

SECTION 12 OF THE RAILROAD RETIREMENT ACT PROVIDES FOR THE PAYMENT OF BENEFITS TO A REPRESENTATIVE PAYEE WHEN AN EMPLOYEE, SPOUSE, OR SURVIR ANNUITANT IS INCOMPETENT OR IS A MINOR. THE APPLICATION OBTAINS INFORMATION NEEDED FOR SELECTION OF A REPRESENTATIVE PAYEE.

None
None


No

1
IC Title Form No. Form Name
APPLICATION TO ACT AS REPRESENTATIVE PAYEE AA-5 &, G-478

  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 14,000 3,000 0 0 11,000 0
Annual Time Burden (Hours) 14,667 500 0 0 14,167 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.
03/04/1981


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