Information Collection

Evidence of Marital Relationship - Living with Requirements

IC 33823 under ICR 201201-3220-003 · OMB 3220-0021.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0021 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-124 (05-08) Evidence of Marital Relationship - Living with Requirements	Form
G-124 (05-08) Statement of Marital Relationship Form G-124 (05-08).pdf	Form
G-124A (05-08) Statement Regarding Marriage Form G-124a (05-08).pdf	Form
G-237 (05-08) Statement Regarding Marital Status Form G-237 (05-08).pdf	Form and Instruction
G-238A (10-02) Statement Regarding Divorce or Annulment Form G-238a (10-02).pdf	Form
G-238 (10-02) Statement of Residence Form G-238 (10-02).pdf	Form
Form G-242 (01-07).pdf Notice of Information Needed in Claim under Railroad Retirement Act	IC Document
Form RL-26F (05-08).pdf RL-26, Transmittal Letter, Instruction Sheet	IC Document
Form RL-57A-F (10-82).pdf RL-57A-F, Transmittal letter	IC Document

IC Title:

Evidence of Marital Relationship - Living with Requirements

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 219.3

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	G-124 (05-08)	Statement of Marital Relationship	Form G-124 (05-08).pdf	No	Paper Only
Form	G-124A (05-08)	Statement Regarding Marriage	Form G-124a (05-08).pdf	No	Paper Only
Form and Instruction	G-237 (05-08)	Statement Regarding Marital Status	Form G-237 (05-08).pdf	No	Paper Only
Form	G-238A (10-02)	Statement Regarding Divorce or Annulment	Form G-238a (10-02).pdf	No	Paper Only
Form	G-238 (10-02)	Statement of Residence	Form G-238 (10-02).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: 1,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,100	1,100
Annual IC Time Burden (Hours)	196	196
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Notice of Information Needed in Claim under Railroad Retirement Act	Form G-242 (01-07).pdf	01/24/2012
RL-26, Transmittal Letter, Instruction Sheet	Form RL-26F (05-08).pdf	01/24/2012
RL-57A-F, Transmittal letter	Form RL-57A-F (10-82).pdf	01/24/2012

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