Application for Employee Annuity Under the Railroad Retirement Act

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0002 can be found here:

Documents and Forms

Document Name Document Type
Form RRB Form G-204 Application for Employee Annuity Under the Railroad Retirement Act Form and Instruction
RRB Form G-204 Verification of Worker's Compensation/Public Disability Form G-204 (11-02).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Employee Annuity Under the Railroad Retirement Act	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 220 20 CFR 216

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RRB Form G-204	Verification of Worker's Compensation/Public Disability	Form G-204 (11-02).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: RRB-22; Railroad Retirement, Survivor, and Pensioner Benefit System	FR Citation: 40 FR 36268

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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