Application for Survivor Death Benefits

ICR 200603-3220-003

OMB: 3220-0031

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
33838 Migrated
ICR Details
3220-0031 200603-3220-003
Historical Active 200302-3220-001
RRB
Application for Survivor Death Benefits
Extension without change of a currently approved collection   No
Regular
Approved without change 05/23/2006
Retrieve Notice of Action (NOA) 03/28/2006
  Inventory as of this Action Requested Previously Approved
05/31/2009 05/31/2009 06/30/2006
20,600 0 20,600
5,150 0 5,150
0 0 0

The collection obtains the information needed to pay death benefits and annuities due but unpaid at death under the Railroad Retirement Act. Benefits are paid to designated beneficiaries or to survivors in a priority designated by law.

None
None


No

1
IC Title Form No. Form Name
Application for Survivor Death Benefits G-273A, AA-11A, G-131, AA-21, AA-21CERT

  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 20,600 20,600 0 0 0 0
Annual Time Burden (Hours) 5,150 5,150 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.
03/28/2006


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