APPLICANT'S STATEMENT REGARDING ALLEGED ADOPTION; AND STATEMENT REGARDING ALLEGED ADOPTION

ICR 198103-3220-018

OMB: 3220-0040

Federal Form Document

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Name
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ICR Details
3220-0040 198103-3220-018
Historical Active 198102-3220-048
RRB
APPLICANT'S STATEMENT REGARDING ALLEGED ADOPTION; AND STATEMENT REGARDING ALLEGED ADOPTION
No material or nonsubstantive change to a currently approved collection   No
Emergency 03/21/1981
Approved with change 03/21/1981
Retrieve Notice of Action (NOA) 03/21/1981
  Inventory as of this Action Requested Previously Approved
05/31/1981 05/31/1981 03/31/1981
400 0 400
100 0 100
0 0 0

THE RAILROAD RETIREMENT ACT PROVIDES FOR THE PAYMENT OF AN INSURANCE ANNUITY TO A CHILD ALLEGED TO HAVE BEEN ADOPTED BY THE DECEASED RAILROAD EMPLOYEE IF THE CHILD MEETS THE DEPENDENCY REQUIREMENTS UNDER THE ACT. THE STATEMENTS EXECUTED BY THE APPLICANT FILING ON THE CHILD'S BEHALF, OR OTHER PERSON IN SUPPORT OF THE APPLICATION, WILL BE USED FOR DETERMINING WHETHER THE CHILD IS ENTITLED TO BENEFITS

None
None


No

1
IC Title Form No. Form Name
APPLICANT'S STATEMENT REGARDING ALLEGED ADOPTION; AND STATEMENT REGARDING ALLEGED ADOPTION G-118,, G-118A

  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 400 400 0 0 0 0
Annual Time Burden (Hours) 100 100 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.
03/21/1981


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