Self-Employment and Substantial Service Questionnaire

ICR 201010-3220-005

OMB: 3220-0138

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2010-10-27
IC Document Collections
IC ID
Document
Title
Status
33934 Modified
ICR Details
3220-0138 201010-3220-005
Historical Active 200707-3220-005
RRB
Self-Employment and Substantial Service Questionnaire
Extension without change of a currently approved collection   No
Regular
Approved without change 02/14/2011
Retrieve Notice of Action (NOA) 10/27/2010
  Inventory as of this Action Requested Previously Approved
02/28/2014 36 Months From Approved 02/28/2011
600 0 600
415 0 415
0 0 0

Section 2 of the Railroad Retirement Act provides for payment of annuities to qualified employees and their spouses. Work for a Last Pre-Retirement Nonrailroad Employer (LPE), and work in self-employment affect payment in different ways. This collection obtains information to determine whether claimed self-employment is really self-employment, and not work for a railroad or LPE.

US Code: 45 USC 231f Name of Law: Railroad Retirement Act
  
None

Not associated with rulemaking

  75 FR 51117 08/18/2010
75 FR 65678 10/26/2010
No

1
IC Title Form No. Form Name
Self-Employment Questionnaire AA-4 (01-08) Self-Employment and Substantial Service Questionnaire

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 600 600 0 0 0 0
Annual Time Burden (Hours) 415 415 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
Yes
No
No
No
Uncollected
Charles Mierzwa 312-751-3363 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/27/2010


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