SURVIVOR QUESTIONNAIRE

ICR 199103-3220-001

OMB: 3220-0032

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
157350 Migrated
ICR Details
3220-0032 199103-3220-001
Historical Active 198904-3220-014
RRB
SURVIVOR QUESTIONNAIRE
Extension without change of a currently approved collection   No
Regular
Approved without change 05/28/1991
Retrieve Notice of Action (NOA) 03/22/1991
  Inventory as of this Action Requested Previously Approved
05/31/1994 05/31/1994 06/30/1991
26,500 0 26,500
4,605 0 4,605
0 0 0

UNDER SECTION 6 OF THE RAILROAD RETIREMENT ACT BENEFITS ARE PAYABLE TO THE SURVIVORS OR THE ESTATES OF DECEASED RAILROAD EMPLOYEES. THE COLLECTION OBTAINS INFORMATION ABOUT THE SURVIVORS, IF ANY, PAYMENT OF BURIAL EXPENSES AND ADMINISTRATION OF ESTATE WHEN UNKNOWN TO THE BOARD. THE INFORMATION WILL BE USED TO DETERMINE WHETHER AND TO WHOM BENEFITS ARE PAYABLE.

None
None


No

1
IC Title Form No. Form Name
SURVIVOR QUESTIONNAIRE RL-94-F

  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 26,500 26,500 0 0 0 0
Annual Time Burden (Hours) 4,605 4,605 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.
03/22/1991


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