Information Collection

Employee Non-Covered Service Pension Questionnaire

IC 33954 under ICR 201409-3220-002 · OMB 3220-0154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-209 Employee Non-Covered Service Pension Questionnaire	Form and Instruction
G-209 Employee Non-Covered Service Pension Questionnaire Form G-209 (10-11).pdf	Form and Instruction

IC Title:

Employee Non-Covered Service Pension Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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 and Instruction	G-209	Employee Non-Covered Service Pension Questionnaire	Form G-209 (10-11).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 Sytem

FR Citation: 75 FR 43727

Number of Respondents: 150

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	150	150
Annual IC Time Burden (Hours)	14	14
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.