Information Collection

Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment

IC 33989 under ICR 200812-3220-004 · OMB 3220-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0179 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-19L (12-07) Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment	Form
G-19L (12-07) Annual Earnings Questionnaire for Annuitants in Last Per Form G-19L (12-07).pdf	Form
G-19L (proposed) Annual Earnings Questionnaire for Annuitants in Last Per Form G-19L (proposed).pdf	Form and Instruction
Form G-19L1 (12-07).pdf G-19L.1, Instructions for Completing the Annual Earnings Questionnaire	IC Document

IC Title:

Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment

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 230.2 20 CFR 230.1

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-19L (12-07)	Annual Earnings Questionnaire for Annuitants in Last Person Service	Form G-19L (12-07).pdf		No		Paper Only
Form and Instruction	G-19L (proposed)	Annual Earnings Questionnaire for Annuitants in Last Person Service	Form G-19L (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 73516

Number of Respondents: 300

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	300	300
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
G-19L.1, Instructions for Completing the Annual Earnings Questionnaire	Form G-19L1 (12-07).pdf	12/18/2008

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