3220-0187

OMB No. 3220-0187

Justification

Continuing Disability Report

RRB Forms G-254 and G-254a

1. Circumstances of information collection - Under section 2 of the Railroad Retirement Act (RRA), an annuity is not payable or is reduced for any months in which the annuitant works for a railroad or earns more than prescribed dollar amounts from either non-railroad employment or self-employment. Certain types of work may indicate an annuitant's recovery from disability. The provisions relating to the reduction or nonpayment of annuities by reason of work and an annuitant's recovery from disability for work are prescribed in 20 CFR 220.17-220.20.

The Railroad Retirement Board (RRB) conducts continuing disability reviews (CDR) to determine whether annuitants continue to meet the disability requirements of the law. Payment of disability benefits and/or a beneficiary’s period of disability ends if medical evidence or other information shows that an annuitant is not disabled under the standards prescribed in section 2 of the RRA. A CDR is generally conducted if (1) the annuitant is scheduled for a routine periodic review, (2) the annuitant returns to work and successfully completes a trial work period, (3) substantial earnings are posted to the annuitant’s wage record, or (4) information is received from the annuitant or a reliable source that the annuitant has recovered or returned to work. Provisions relating to when and how often the RRB conducts disability reviews are prescribed in 20 CFR 220.186.

2. Purposes of collecting, consequences of not collecting the information - Form G-254, Continuing Disability Report, is used by the RRB to develop information for a CDR determination, including a determination prompted by a report of work, return to railroad service, allegations of medical improvement, or a routine disability review call-up. The form obtains information about a disabled annuitant's work activity and any medical treatment received by the annuitant during the report period shown in Section 1 of the form.

Completion of Form G-254 is necessary when information about work activity or a change in the physical or mental condition of a disability annuitant is received at RRB headquarters. This type of information is received from various sources, including telephone calls or letters from the annuitants themselves or from other individuals, or from earnings information received from the Social Security Administration and State Employment Service(s) and other outside sources. Whenever such information is received, an RRB field office is requested to secure a completed Form G-254 from the disability annuitant. This is usually accomplished by an in-person interview or over the telephone. In some cases, the field office mails Form G‑254, which is designed for self-completion, to the annuitant. The identifying information requested in Section 2 of the G-254 is entered by the RRB field office from information already available on RRB records prior to completion of the form whether by interview or by mail. When mailed, the form is transmitted by Form RL-254 and a self-addressed envelope is enclosed for returning the completed G-254 to the RRB field office.

Items 7(a), (b) and (c) of Form G-254 request the name, address, and telephone number of the annuitant's employer(s). In about 10 percent of the cases, RRB headquarters requests a field office to contact the employer(s) listed in these items to verify the annuitant's period of employment and wages earned. Likewise, the RRB will request that a field office contact a doctor, hospital, or clinic identified in items 27, 29 and 30, or a vocational rehabilitation agency or counselor identified in item 32 to verify information provided by an annuitant. The field office then forwards the information to RRB Headquarters.

The RRB proposes the following changes to Form G-254.

• Revise current Item 8 to ask for the response in month and year format since the form may cover multiple years.

• Revise current Item 12a to include the spouse as a source of employment.

• Revise current Item 15k to ask if the annuitant had to reduce the number of their clients or customers to show the impact the disability has had on their business.

• Revise current Items 17a and 17b to include asking if the annuitant has made supervisory (as well as managerial) decisions.

• Renumber current Item 31 to Item 31a.

• Create New Item 31b, using a Yes/No format, to identify the annuitant who requires an assistive device.

• Create New Item 31c to identify the assistive device(s) such as a cane, oxygen, etc.

• Other minor editorial changes.

Form G-254a, Continuing Disability Update Report, is used to help identify annuitants whose work activity and/or recent medical history warrant completion of Form G-254, Continuing Disability Report, for a more extensive review. The questionnaire is mailed to a disability annuitant or representative payee scheduled for routine periodic review. Based on the annuitant’s or representative payee’s responses to Form G-254a, the RRB makes a determination whether to rediary the case for review at a later date, or to request completion of the more comprehensive Form G-254. The primary purpose and focus of the G-254a is to provide a means to screen cases scheduled for review and then focus the available resources on cases with the greatest potential for significant findings. Use of Form G-254a reduces the number of annuitants asked to complete the comprehensive G-254. Form G-254a is transmitted by Form RL-254a, which includes the Paperwork Reduction Act and Privacy Act Notices for Form G-254a.

The RRB proposes to expand the name and address field on Form G-254a to include a request for the social security number of an applicant who is not the employee.

The Paperwork Reduction Act and Privacy Act Notices are on the front of the G-254 and G‑254a.

3. Planned use of improved information technology or technical/legal impediments to further burden reduction – No Internet processing is planned at this time because both forms are initiated by the RRB, utilizing prefills from information resident in RRB automated systems. Future development will be subject to technology and budgetary constraints.

4. Efforts to identify duplication - This information collection does not duplicate any other RRB information collection.

5. Small business respondents - N.A.

6. Consequences of less frequent collection - Obtaining the employment, earnings, and medical information less frequently would affect the accurate payment of disability annuities under the Railroad Retirement Act.

7. Special circumstances - N.A.

8. Public comments/consultations outside the agency - In accordance with 5 CFR 1320.8 (d), comments were invited from the public regarding the information collection. The notice to the public was published on page 13921 of the March 17, 2015, Federal Register. No comments or requests for additional information were received from the public.

9. Payments or Gifts to Respondents - N.A.

10. Confidentiality - Privacy Act System of Records, RRB-22, Railroad Retirement Survivor and Pension Benefit System. In accordance with OMB Circular M-03-22, a Privacy Impact Assessment for this information collection was completed and can be found at http://www.rrb.gov/pdf/PIA/PIA-BPO.pdf.

11. Sensitive questions - N.A.

12. Estimate of respondent burden - The current burden estimate for the information collection is unchanged as follows:

Current Burden

Form Number	Annual Responses	Time (Minutes)	Burden (Hours)
G-254 Annuitant	1,000	35	583
Employer verification	100	5	8
Doctor, hospital, or clinic verification	100	5	8
Vocational, Rehabilitation Counselor verification)	100	5	8
Other governmental agency verification	100	5	8
School verification	100	5	8
G-254a	1,500	5	125
Total	3,000		748

13. Estimate of annual cost to respondents or record keepers - N.A.

14. Estimate of cost to Federal Government - N.A.

15. Explanation for change in burden - N.A.

16. Time schedule for data collections and publications - The results of this collection will not be published.

17. Request not to Display OMB expiration date - The G-254 and G-254a are seldom revised. Given the costs associated with redrafting, reprinting, and distributing the form in order to keep the appropriate OMB expiration date in place, the RRB requests the authority to not display the expiration date on the form.

18. Exceptions to Certification Statement - None

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