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Form AA-12 (xx-xx) AA-12 (xx-xx) Notice of Death and Request for Service Needed for Eligi
Employer Reporting
Form AA-12 Proposed
Notice of Death and Statement of Compensation
OMB: 3220-0005
OMB.report
RRB
OMB 3220-0005
ICR 200610-3220-001
IC 45663
Form AA-12 (xx-xx) AA-12 (xx-xx) Notice of Death and Request for Service Needed for Eligi
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3220-0005 can be found here:
2022-09-21 - Extension without change of a currently approved collection
2019-04-30 - Revision of a currently approved collection
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File Modified
2006-07-07
File Created
2006-07-07
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