Earnings Information Request

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0184 can be found here:

Documents and Forms

Document Name Document Type
Form G-19-F (07-04) Earnings Information Request Form
G-19-F (07-04) Earnings Information Request Form G-19F (current).pdf Form
G-19F (proposed) Earnings Information Request Form G-19F (Proposed).pdf Form
Form G-254 (01-07).pdf G-254; Continuing Disability Report IC Document
Form G-19L (12-06).pdf G-19L; Annual Earnings Questionnaire IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Earnings Information Request	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 230

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	G-19-F (07-04)	Earnings Information Request	Form G-19F (current).pdf		No		Paper Only
Form	G-19F (proposed)	Earnings Information Request	Form G-19F (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 Pension Benefit System	FR Citation: 40 FR 36268

Number of Respondents: 900	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	Previously Approved
Annual Number of Responses for this IC	900	-100	1,000
Annual IC Time Burden (Hours)	120	-13	133
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
G-254; Continuing Disability Report	Form G-254 (01-07).pdf	07/13/2007
G-19L; Annual Earnings Questionnaire	Form G-19L (12-06).pdf	07/13/2007

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