Information Collection

Application for Spouse Annuity Under the Railroad Retirement Act

IC 33861 under ICR 200611-3220-001 · OMB 3220-0042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0042 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AA-3cert Application for Spouse Annuity Under the Railroad Retirement Act	Form
AA-3 Application for Spouse/Divorced Spouse Annuity AA-3 (05-04)(current).pdf	Form
AA-3 (proposed) Application for Spouse/Divorced Spouse Annuity AA-3(proposed).pdf	Form
AA-3cert Application Summary and Certification AA-3cert(07-02)current.pdf	Form
AA-3cert (proposed Application Summary and Certification AA-3cert(proposed).pdf	Form
AA-7 (01-03).pdf AA-7, Spouse/Divorced Application for Medicare	IC Document
G-208 (09-04).pdf G-208, Public Service Pension Questionnaire	IC Document
G-19F (07-04).pdf G-19F, Earnings Information Request	IC Document
RL-1 (07-03).pdf RL-1	IC Document
RB-3 (08-04).pdf RB-3	IC Document
RB-30 (06-04).pdf RB-30	IC Document
RB-9 (05-04).pdf RB-9	IC Document

IC Title:

Application for Spouse Annuity Under the Railroad Retirement Act

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 216.50 20 CFR 218.11

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AA-3cert	Application Summary and Certification	AA-3cert(07-02)current.pdf	Yes	Yes	Fillable Printable
Form	AA-3cert (proposed)	Application Summary and Certification	AA-3cert(proposed).pdf	Yes	Yes	Fillable Printable
Form	AA-3 (proposed)	Application for Spouse/Divorced Spouse Annuity	AA-3(proposed).pdf	No		Paper Only
Form	AA-3	Application for Spouse/Divorced Spouse Annuity	AA-3 (05-04)(current).pdf	Yes	No	Paper Only

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records

Title: RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System

FR Citation: 40 FR 36268

Number of Respondents: 8,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	8,500	8,500
Annual IC Time Burden (Hours)	4,297	4,297
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
RL-1	RL-1 (07-03).pdf	11/22/2006
RB-3	RB-3 (08-04).pdf	11/22/2006
RB-30	RB-30 (06-04).pdf	11/22/2006
RB-9	RB-9 (05-04).pdf	11/22/2006
AA-7, Spouse/Divorced Application for Medicare	AA-7 (01-03).pdf	12/04/2006
G-208, Public Service Pension Questionnaire	G-208 (09-04).pdf	12/04/2006
G-19F, Earnings Information Request	G-19F (07-04).pdf	12/04/2006

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.