Information Collection

Earnings Information Request

IC 33996 under ICR 200707-3220-003 · OMB 3220-0184.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.