Application for Survivor Insurance Annuities

ICR 200403-3220-001

OMB: 3220-0030

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
33834 Migrated
ICR Details
3220-0030 200403-3220-001
Historical Active 200102-3220-003
RRB
Application for Survivor Insurance Annuities
Extension without change of a currently approved collection   No
Regular
Approved without change 04/05/2004
Retrieve Notice of Action (NOA) 03/04/2004
  Inventory as of this Action Requested Previously Approved
04/30/2007 04/30/2007 06/30/2004
4,137 0 4,137
1,718 0 1,718
0 0 0

Under Seciton 2(d) of the Railroad Retirement Act, monthly survivor annuities are payable to surviving widow(er)s, parents, unmarried children, and in certain cases, divorced wives (husbands), mothers (fathers), remarried widow(er)s and grandchildren of deceased railroad employees. The collection obtains information needed by the RRB for determining entitlement to and amount of the annuity applied for.

None
None


No

1
IC Title Form No. Form Name
Application for Survivor Insurance Annuities AA-17CERT, AA-18, AA-17, AA-17B, AA-19, AA-19A, AA-20

  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 4,137 4,137 0 0 0 0
Annual Time Burden (Hours) 1,718 1,718 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.
03/04/2004


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