Survivor Questionnaire

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0032 can be found here:

Documents and Forms

Document Name Document Type
Form RL-94F (06-03) Survivor Questionnaire Form and Instruction
RL-94F (06-03) Survivor Questionnaire Form RL-94F (06-03).pdf Form and Instruction
RL-94F (proposed) Survivor Questionnaire Form RL-94F (proposed).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survivor Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 234

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RL-94F (06-03)	Survivor Questionnaire	Form RL-94F (06-03).pdf		No		Paper Only
Form and Instruction	RL-94F (proposed)	Survivor Questionnaire	Form RL-94F (proposed).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records
Title: RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System	FR Citation: 72 FR 73516

Number of Respondents: 8,000	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	8,000	8,000
Annual IC Time Burden (Hours)	1,391	1,391
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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