Information Collection

Self-Employment Questionnaire

IC 33934 under ICR 200707-3220-005 · OMB 3220-0138.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0138 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AA-4 (07-01) Self-Employment Questionnaire	Form and Instruction
AA-4 (07-01) Self-Employment and Substantial Service Questionnaire AA-4 (07-01).pdf	Form and Instruction
AA-4 (proposed) Self-Employment and Substantial Service Questionnaire Form AA-4 (proposed).pdf	Form and Instruction
AA-1(5-04).pdf Application for Employee Annuity	IC Document
AA-3 (3-07).pdf Application for Spouse/Divorced Spouse Annuity	IC Document

IC Title:

Self-Employment Questionnaire

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 216.11-16

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 and Instruction	AA-4 (07-01)	Self-Employment and Substantial Service Questionnaire	AA-4 (07-01).pdf		No		Paper Only
Form and Instruction	AA-4 (proposed)	Self-Employment and Substantial Service Questionnaire	Form AA-4 (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: 72 FR 24635

Number of Respondents: 600

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	Previously Approved
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	415	415
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Application for Employee Annuity	AA-1(5-04).pdf	07/27/2007
Application for Spouse/Divorced Spouse Annuity	AA-3 (3-07).pdf	07/27/2007

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