Authorization to Disclose Information to the Railroad Retirement Board

Medical Reports

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0038 can be found here:

Documents and Forms

Document Name Document Type
Form G-197 (09-05) Authorization to Disclose Information to the Railroad Retirement Board Form and Instruction
G-197 (09-05) Authorization to Disclose Information to the Railroad Re Form G-197 (09-05).pdf Form and Instruction
G-197 (proposed) Authorization to Disclose Information to the Railroad Re Form G-197 (proposed).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Authorization to Disclose Information to the Railroad Retirement Board	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 220

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	G-197 (09-05)	Authorization to Disclose Information to the Railroad Retirement Board	Form G-197 (09-05).pdf		No		Paper Only
Form and Instruction	G-197 (proposed)	Authorization to Disclose Information to the Railroad Retirement Board	Form G-197 (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: 75 FR 43727

Number of Respondents: 6,000	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	6,000	6,000
Annual IC Time Burden (Hours)	1,000	1,000
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.