Evidence of Marital Relationship - Living with Requirements

ICR 200511-3220-002

OMB: 3220-0021

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3220-0021 200511-3220-002
Historical Active 200210-3220-004
RRB
Evidence of Marital Relationship - Living with Requirements
Extension without change of a currently approved collection   No
Regular
Approved without change 12/27/2005
Retrieve Notice of Action (NOA) 11/09/2005
  Inventory as of this Action Requested Previously Approved
12/31/2008 12/31/2008 01/31/2006
1,100 0 1,100
196 0 196
0 0 0

Under the RRA, to obtain a benefit as a spouse of an employee annuitant or as the widow(er) of the deceased employee, applicants must submit information to be used in determining if they meet the marriage requirements for such benefits. The collection obtains information supporting claimed common-law marriage, termination of previous marriages and residency requirements.

None
None


No

1
IC Title Form No. Form Name
Evidence of Marital Relationship - Living with Requirements G-124, G-124A, G-237, G-238, G-238A

  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 1,100 1,100 0 0 0 0
Annual Time Burden (Hours) 196 196 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.
11/09/2005


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