Repayment of Debt

Forms and Documents

Document Name	Status
Form G-421F (04-10) Repayment by Credit Card Form	Modified
Form G-421F (04-10) Repayment by Credit Card Form	Modified
Form DR-422C (07-08).pdf Supplementary Document	2013-04-26
3220-0169.doc Supporting Statement A	2013-04-26
DR-422d (04-05).pdf Supplementary Document	2006-09-29
Form DR-422A (07-08).pdf Supplementary Document	2013-04-26
Form G-421 (04-08).pdf Supplementary Document	2013-04-26
G-66B (02-03).pdf Supplementary Document	2006-09-29
G-66 (02-03).pdf Supplementary Document	2006-09-29
Form G-66A (05-08).pdf Supplementary Document	2013-04-26

IC Document Collections

IC ID	Document Title	Status
45464	Repayment by Credit Card Form	Modified
33968	Repayment by Credit Card Form	Modified

ICR Details

OMB Control No: 3220-0169	ICR Reference No: 201304-3220-001
Status: Historical Active	Previous ICR Reference No: 200912-3220-001
Agency/Subagency: RRB	Agency Tracking No:
Title: Repayment of Debt
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/21/2013
	Date Received in OIRA: 04/26/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	36 Months From Approved	08/31/2013
Responses	535	0	300
Time Burden (Hours)	45	0	25
Cost Burden (Dollars)	0	0	0

---

Abstract: When the RRB determines that an overpayment of benefits under the Railroad Retirement Act or Railroad Unemployment Insurance Act has occurred, it initiates prompt action to notify the claimant of the overpayment and to recover the amount owed. The collection obtains information needed to allow for repayment by the claimant by credit card, in addition to the customary form of payment by check or money order.

---

Authorizing Statute(s): US Code: 45 USC 231(i) Name of Law: Railroad Retirement Act
   US Code: 45 USC 362(l) Name of Law: Railroad Unemployment Insurance Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 6152	01/29/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 23559	04/19/2013
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Repayment by Credit Card	G-421F (proposed), G-421F (04-10)	Repayment by Credit Card ,   Repayment By Credit Card
Repayment by Credit Card	G-421F(proposed), G-421F (04-10)	Repayment by Credit Card ,   Repayment by Credit Card

---

ICR Summary of Burden

	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	535	300	0	0	235	0
Annual Time Burden (Hours)	45	25	0	0	20	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The adjustment of +235 responses and +20 burden hours are due largely to improved internal tracking methods.

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/26/2013

---