Application for Survivor Death Benefits

Application for Survivor Death Benefits

OMB: 3220-0031

IC ID: 33838

Information Collection (IC) Details

View Information Collection (IC)

Application for Survivor Death Benefits
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 234 20 CFR 217 20 CFR 219

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction AA-21 (11-08) Application for Lump-Sum Death Payments and Annuities Unpaid at Death Form AA-21 (11-08).pdf Yes Yes Paper Only
Form and Instruction G-131 Authorization of Payment and Release of All Claims to a Death Benefit or Accrued Annuity Payment Form G-131 (06-06).pdf No   Paper Only
Form and Instruction AA-11a (09-03) Designation or Change of Beneficiary for Employees with Service Prior to January 1, 1975, for Residual Lump Sum Form AA-11a (09-03).pdf No   Paper Only
Form AA-21CERT Application Summary and Certification Form AA-21cert (02-00) Example.pdf Yes Yes Fillable Printable
Form and Instruction AA-21 Application for Lump-Sum Death Payments and Annuities Unpaid at Death Form AA-21 (proposed).pdf Yes Yes Paper Only
Form and Instruction AA-11a Designation or Change of Beneficiary for Employees with Service Prior to January 1, 1975 for Residual Lump Sum Form AA-11a (proposed).pdf No   Paper Only
Form and Instruction G-131 Authorization of Payment and Release of All Claims to a Death Benefit or Accrued Annuity Payment Form G-131 (proposed).pdf No   Paper Only

Income Security Survivor Compensation

RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System  79 FR 58874

3,800 0
   
Individuals or Households
 
   92 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,800 0 0 -1,700 0 5,500
Annual IC Time Burden (Hours) 1,308 0 0 -459 0 1,767
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
AA-21, All Possible Form AA-21cert (02-00) All Possible.pdf 05/26/2009
AA-21rec, Application for Survivor Benefits - Receipt for Claim Form AA-21rec (11-08).pdf 09/28/2015
G-131A, Transmittal for Form G-131 Form G-131A (06-06).pdf 09/28/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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