Information Collection

Application for Employee Annuity Under the Railroad Retirement Act

IC 33796 under ICR 200611-3220-002 · OMB 3220-0002.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AA-1d Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction
AA-1 Application for Employee Annuity Form AA-1 (05-04).pdf	Form and Instruction
AA-1d Application for Determination of Employee Disability Form AA-1d (05-04).pdf	Form and Instruction
AA-1 Application for Employee Annuity AA-1 (proposed).pdf	Form and Instruction
AA-1d Application for Employee Disability AA-1d (proposed).pdf	Form and Instruction
AA-1cert Application Summary and Certification AA-1cert (proposed).pdf	Form and Instruction
AA-1cert Application Summary and Certification AA-1cert (07-02).pdf	Form

IC Title:

Application for Employee 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 220 20 CFR 216

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 and Instruction	AA-1d	Application for Determination of Employee Disability	Form AA-1d (05-04).pdf	No		Paper Only
Form and Instruction	AA-1	Application for Employee Annuity	Form AA-1 (05-04).pdf	No		Paper Only
Form and Instruction	AA-1	Application for Employee Annuity	AA-1 (proposed).pdf	No		Paper Only
Form	AA-1cert	Application Summary and Certification	AA-1cert (07-02).pdf	Yes	Yes	Paper Only
Form and Instruction	AA-1cert	Application Summary and Certification	AA-1cert (proposed).pdf	Yes	Yes	Paper Only
Form and Instruction	AA-1d	Application for Employee Disability	AA-1d (proposed).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: 13,065

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 72 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	18,070	-1,030	19,100
Annual IC Time Burden (Hours)	9,488	-595	10,083
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.