3220-0184

OMB NO. 3220-0184

Justification

Earnings Information Request

Form G-19-F

1. Circumstances of the collection - Under Section 2 of the Railroad Retirement Act, an annuity is not payable, or is reduced for any month(s) in which the beneficiary works for a railroad or earns more than prescribed amounts. The provisions relating to the reduction or non-payment of annuities by reason of work are prescribed in 20 CFR 230.

2. Purposes of collecting/consequences of not collecting the information - To obtain the information needed to determine if an annuity is not payable to an applicant because of earnings in excess of prescribed amounts, the Railroad Retirement Board (RRB) uses a series of basic application forms to request specific information relating to an applicant's past, present, and future earnings. To obtain information needed for determining reductions in, or non-payment of, annuities currently being paid to annuitants, the RRB primarily relies on earnings information received from the Social Security Administration under a computer matching program agreement. The RRB also uses Form G-19L, Annual Earnings Questionnaire (OMB No. 3220-0179), and Form G‑254, Continuing Disability Report (OMB No. 3220-0187).

In some cases, an applicant or annuitant fails to furnish the earnings information or enters erroneous information on an RRB form. In other cases, the RRB receives information from various sources relating to an applicant's or annuitant's earnings, including telephone calls or correspondence from the applicant or annuitant involved, other RRB forms used for monitoring earnings, and information received from the Social Security Administration. In the majority of cases, Form G-19-F is mailed to the applicant or annuitant when earnings information needs to be verified.

Form G-19-F, Earnings Information Request, is used by the RRB to obtain earnings information when needed. The form is comprised of six information items, all of which pertain to an individual's employment for hire or self-employment for a time period of either 1 or 2 calendar years. The particular calendar year(s) for which the earnings information is needed is prefilled by the RRB field office in items 1and 3, and, when appropriate, in items 4 and 5, before the form is released. The releasing field office also enters an "x" in the box provided on the left side of items 4, 5, and 6 indicating that a respondent is to complete that particular item or items. If for some reason, earnings information is needed for more than 2 calendar years, the RRB furnishes a second Form G-19-F for completion by the respondent. If SSA reported earnings during computer matching, the RRB’s mainframe version of G‑19-F requests earnings for the year SSA reported earnings and the year following.

The transmittal letter, which is the first page of Form G-19-F, provides instructions for completing Form G-19-F and furnishing Form W-2, Wage and Tax Statement, Schedule SE (Form 1040), Self-Employment Tax, and Form 1040, U.S. Individual Income Tax Return, when applicable. The RRB field office enters a reference ID number in the top portion of the transmittal letter for identification purposes before release. The mainframe and manual versions of the form insert the annuitant’s claim number in the top right corner of the second page. A pre-addressed envelope or window envelope is enclosed for the respondent to use to return the completed Form G-19-F to the appropriate RRB field office.

The RRB proposes no changes to Form G-19-F.

To our knowledge no other agency uses a form similar to RRB Form G-19-F.

3. Planned use of improved information technology or technical/legal impediments to further burden reduction – Not practicable for Internet submission because this form is initiated by the RRB with pre-filled data. Also, overall volume is low and falling.

4. Efforts to identify duplication and other improvements - This information collection does not duplicate any other information collection.

5. Small business respondents - N.A.

6. Consequences of less frequent collection - Not applicable since the information is obtained only once for each incident involving omitted or erroneous information.

7. Special circumstances - None.

8. Consultations outside the agency - In accordance with 5 CFR 1320.8(d), comments were invited from the public regarding the information collection. The notice to the public was published on page 41557 of the July 16, 2010, Federal Register. No comments or requests for additional information were received.

9. Payments or gifts to respondents - None.

10. Confidentiality - Privacy Act System of Records, RRB-22, Railroad Retirement, Survivor and Pension Benefit System - RRB. An RRB Privacy Impact Assessment that includes RRB-22 can be found at the following link: http://www.rrb.gov/pdf/PIA/PIA-BPO.pdf

11. Sensitive questions - None.

12. Estimate of respondent burden - The estimated burden for this collection has not changed.

Current Burden

Form Number	Annual Responses	Time (Minutes)	Burden (Hours)
G-19-F	900	8	120
Total	900		120

13. Estimated annual cost to respondents or record keepers - N.A.

14. Estimate of cost to Federal Government - N.A.

15. Explanation for changes in burden - N.A.

16. Time schedule for data collections and publications - The results of this collection will not be published.

17. Request not to display OMB expiration date - The form associated with this collection is seldom revised. Given the costs associated with redrafting, reprinting, and distributing the form in order to keep the appropriate expiration date in place, the RRB requests the authority to not display the OMB expiration date on the form.

18. Exceptions to Certification Statement - None

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