Information Collection

Public Service Pension Questionnaires

IC 33931 under ICR 201401-3220-010 · OMB 3220-0136.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0136 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-208 (04-11) Public Service Pension Questionnaires	Form
G-208 (04-11) Public Service Pension Questionnaire Form G-208 (04-11).pdf	Form
G-212 (01-09) Public Service Pension Monitoring Questionnaire Form G-212 (01-09).pdf	Form
Form SSA-3885 (07-2011).pdf SSA-3885	IC Document

IC Title:

Public Service Pension Questionnaires

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 219.64(c)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	G-208 (04-11)	Public Service Pension Questionnaire	Form G-208 (04-11).pdf		No		Paper Only
Form	G-212 (01-09)	Public Service Pension Monitoring Questionnaire	Form G-212 (01-09).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: 1,170

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	1,170	1,170
Annual IC Time Burden (Hours)	294	294
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-3885	Form SSA-3885 (07-2011).pdf	03/25/2014

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