Public Service Pension Questionnaires

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0136 can be found here:

Documents and Forms

Document Name Document Type
Form G-212 (proposed) Public Service Pension Questionnaires Form
G-208 (09-04) Public Service Pension Questionnaire Form G-208 (09-04).pdf Form
G-212 (05-04) Public Service Pension Monitoring Questionnaire Form G-212 (05-04).pdf Form
G-212 (proposed) Public Service Pension Monitoring Questionnaire Form G-212 (proposed).pdf Form
Form SSA-3885 (08-1999).pdf SSA-3885 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Public Service Pension Questionnaires	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 219.64(c)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	G-212 (proposed)	Public Service Pension Monitoring Questionnaire	Form G-212 (proposed).pdf	No	Paper Only
Form	G-208 (09-04)	Public Service Pension Questionnaire	Form G-208 (09-04).pdf	No	Paper Only
Form	G-212 (05-04)	Public Service Pension Monitoring Questionnaire	Form G-212 (05-04).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: 72 FR 24631

Number of Respondents: 1,170	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,170	1,170
Annual IC Time Burden (Hours)	294	294
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-3885	Form SSA-3885 (08-1999).pdf	07/13/2007

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