Application for Survivor Insurance Annuities

Application for Survivor Insurance Annuities

OMB: 3220-0030

IC ID: 33834

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Information Collection (IC) Details

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Application for Survivor Insurance Annuities
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 218 20 CFR 219 20 CFR 216 20 CFR 217

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form AA-17B Application for Determination of Widow(ers) Disability Form AA-17b (06-04).pdf No   Paper Only
Form AA-18 Application for Mother's/Father's and Child Annuity Form AA-18 (04-04).pdf No   Paper Only
Form AA-19 Application for Child's Annuity Form AA-19 (05-04).pdf No   Paper Only
Form AA-19A Application for Determination of Child's Disability Form AA-19 (05-04).pdf No   Paper Only
Form AA-20 Application for Parent's Annuity Form AA-20 (04-04).pdf No   Paper Only
Form and Instruction AA-17 (proposed) Application for Widow(ers) Annuity Form AA-17 (proposed).pdf No   Paper Only
Form AA-17b (proposed) Application for Determination of Widow(ers) Disability Form AA-17b (proposed).pdf No   Paper Only
Form AA-18 (proposed) Application for Mother's/Father's and Child Annuity AA-18 (Proposed).pdf No   Paper Only
Form AA-19 (proposed) Application for Child's Annuity Form AA-19 (proposed).pdf No   Paper Only
Form AA-20 (proposed) Application for Parent's Annuity Form AA-20 (proposed).pdf No   Paper Only
Form AA-17cert Application Summary and Certification AA-17cert(Allpossible).pdf No   Paper Only
Form AA-17cert Application Summary and Certification AA-17cert(Samplecompleted).pdf No   Paper Only
Form AA-17 Application for Widow(er)'s Annuity Form AA-17 (04-04).pdf No   Paper Only

Income Security General Retirement and Disability

RRB-22, Railroad Retirement, Survivor, and Pensioner Benefit System   40 FR 36268

4,137 0
   
Individuals or Households
 
   79 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,137 0 0 0 0 4,137
Annual IC Time Burden (Hours) 1,718 0 0 0 0 1,718
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
RB-3 Booklet; Furnishing Evidence to Support Your Claim Form RB-3 (08-04).pdf 08/01/2004
RB-17 Booklet, Survivor Annuities Form RB-17 (07-04).pdf 07/01/2004
RB-17b Booklet; Widow(ers) Disability Benefits Form RB-17b (08-04).pdf 08/02/2004
RB-19A Booklet; Child's Disability Benefits RB-19a (5-99).pdf 05/03/1999
AA-17rec; Receipt for Claim AA-17rec.pdf 07/03/2006
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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