Information Collection

Application for Spouse Annuity Under the Railroad Retirement Act

IC 33861 under ICR 201002-3220-001 · OMB 3220-0042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0042 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AA-3 Application for Spouse Annuity Under the Railroad Retirement Act	Form
AA-3 Application for Spouse/Divorced Spouse Annuity Form AA-3 (03-07)(current).pdf	Form
AA-3 (proposed) Application for Spouse/Divorced Spouse Annuity Form AA-3 (proposed).pdf	Form
AA-3cert Application Summary and Certification Form AA-3cert (09-07).pdf	Form
AA-3cert (all poss Application Summary and Certification Form AA-3cert (09-07) all possible.pdf	Form and Instruction
Form RL-1 (04-07).pdf RL-1	IC Document
Form RB-3 (11-08).pdf RB-3, Furnishing Evidence To Support Your Claim	IC Document
Form RB-30 (05-09).pdf RB-30, Spouse/Divorced Spouse Annuity	IC Document
Form RB-09 (03-09).pdf RB-9, Employee and Spouse Annuities - Events That Must Be Reported	IC Document
AA-7 (01-03).pdf AA-7, Spouse/Divorced Application for Medicare	IC Document
G-208 (09-04).pdf G-208, Public Service Pension Questionnaire	IC Document
Form G-19F (10-07).pdf G-19F, Earnings Information Request	IC Document

IC Title:

Application for Spouse Annuity Under the Railroad Retirement Act

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 218.11 20 CFR 216.50

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AA-3	Application for Spouse/Divorced Spouse Annuity	Form AA-3 (03-07)(current).pdf	Yes	No	Paper Only
Form	AA-3 (proposed)	Application for Spouse/Divorced Spouse Annuity	Form AA-3 (proposed).pdf	No		Paper Only
Form	AA-3cert	Application Summary and Certification	Form AA-3cert (09-07).pdf	Yes	Yes	Fillable Printable
Form and Instruction	AA-3cert (all possible)	Application Summary and Certification	Form AA-3cert (09-07) all possible.pdf	Yes	Yes	Fillable Printable

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: 40 FR 36268

Number of Respondents: 11,050

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	11,050	2,550	8,500
Annual IC Time Burden (Hours)	5,642	1,345	4,297
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
RL-1	Form RL-1 (04-07).pdf	02/25/2010
RB-3, Furnishing Evidence To Support Your Claim	Form RB-3 (11-08).pdf	02/25/2010
RB-30, Spouse/Divorced Spouse Annuity	Form RB-30 (05-09).pdf	02/25/2010
RB-9, Employee and Spouse Annuities - Events That Must Be Reported	Form RB-09 (03-09).pdf	02/25/2010
AA-7, Spouse/Divorced Application for Medicare	AA-7 (01-03).pdf	12/04/2006
G-208, Public Service Pension Questionnaire	G-208 (09-04).pdf	12/04/2006
G-19F, Earnings Information Request	Form G-19F (10-07).pdf	02/25/2010

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