Information Collection

Employee's Certification

IC 33938 under ICR 201508-3220-001 · OMB 3220-0140.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0140 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-346 (06-08) Employee's Certification	Form
G-346 (06-08) Employee's Certification Form G-346 (06-08).pdf	Form
G-346sum Employee's Certification Summary Form G-346sum (11-14).pdf	Form
Form AA-7 (01-12).pdf AA-7, Spouse/Divorced Spouse Application for Medicare	IC Document
Form AA-3 (05-10).pdf AA-3, Application for Spouse/Divorced Spouse Annuity	IC Document

IC Title:

Employee's Certification

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 219.30 - 219.35 20 CFR 217(17)(f)(3) (To search for a specific CFR, visit the Code of Federal Regulations.)

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-346 (06-08)	Employee's Certification	Form G-346 (06-08).pdf		No		Paper Only
Form	G-346sum	Employee's Certification Summary	Form G-346sum (11-14).pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records

Title: RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System

FR Citation: 79 FR 58874

Number of Respondents: 6,900

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	6,900	6,900
Annual IC Time Burden (Hours)	575	575
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
AA-7, Spouse/Divorced Spouse Application for Medicare	Form AA-7 (01-12).pdf	05/30/2012
AA-3, Application for Spouse/Divorced Spouse Annuity	Form AA-3 (05-10).pdf	05/30/2012

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