Application for Employee Annuity Under the Railroad Retirement Act

Forms and Documents

Document	Type	Status	Availability
Form AA-1 (07-15) Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified	Available
Form RRB Form G-204 Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified	Available
3220-0002.doc	Supporting Statement A	Uploaded 2016-02-29	Available
Form RL-11b (09-05).pdf	Supplementary Document	Uploaded 2000-07-01	Available
Form RL-1 (04-07).pdf	Supplementary Document	Uploaded 2010-03-24	Available
RB-9 (03-09).pdf	Supplementary Document	Uploaded 2010-03-24	Available
RB-3 (11-08) .pdf	Supplementary Document	Uploaded 2010-03-24	Available
RB-1d (03-09).pdf	Supplementary Document	Uploaded 2010-03-24	Repair queued
RB-1 (05-09).pdf	Supplementary Document	Uploaded 2016-02-29	Available
Form G-251 (05-10).pdf	Supplementary Document	Uploaded 2012-12-07	Available
Form G-250 (08-15).pdf	Supplementary Document	Uploaded 2016-02-29	Available
Form G-209 (10-11).pdf	Supplementary Document	Uploaded 2012-12-07	Available
Form G-204 (11-02).pdf	Supplementary Document	Uploaded 2002-11-01	Available
Form G-77a (11-15).pdf	Supplementary Document	Uploaded 2016-02-29	Available
Form G-19F (10-07).pdf	Supplementary Document	Uploaded 2010-03-24	Repair queued
Form G-3EMP (08-15).pdf	Supplementary Document	Uploaded 2016-02-29	Available
Form AA-6 (01-12).pdf	Supplementary Document	Uploaded 2012-12-07	Available
Form AA-5 (01-04).pdf	Supplementary Document	Uploaded 2001-07-01	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
33796	Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified
178327	Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified

ICR Details

OMB Control No: 3220-0002	ICR Reference No: 201602-3220-002
Status: Historical Active	Previous ICR Reference No: 201212-3220-002
Agency/Subagency: RRB	Agency Tracking No:
Title: Application for Employee Annuity Under the Railroad Retirement Act
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 02/29/2016
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/01/2016
	Date Received in OIRA: 02/29/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	6 Months From Approved	02/29/2016
Responses	15,345	0	17,825
Time Burden (Hours)	8,892	0	9,119
Cost Burden (Dollars)	0	0	0

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Abstract: The Railroad Retirement Act provides for payment of age, disability and supplemental annuities to qualified employees. The application and related forms obtain information about the applicant's family work history, military service, disability benefits from other government agencies and public or private pensions. The information is used to determine entitlement to and the amount of the annuity applied for.

Emergency Justfication: This is the RRB's primary information collection for the processing of retirement and disability applications, and we request an emergency extension of the information collection to avoid a violation of the Paperwork Reduction Act. Changes are being proposed to Form AA-1, AA-cert, AA-1sum and AA-1d in support of the RRB’s Disability Program Improvement Project (DPIP) to enhance/improve disability case processing and overall program integrity as recommended by the RRB’s Office of Inspector General and the Government Accountability Office. Disability case processing and related program integrity issues were also the topic of a 2015 Congressional Hearing by the House Committee on Oversight and Government Reform. After a long and thorough review and evaluation, the RRB is now ready to go forward with significant revisions of the affected forms.

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Authorizing Statute(s): US Code: 45 USC 231a Name of Law: Railroad Retirement Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 9888	02/26/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Application for Employee Annuity Under the Railroad Retirement Act	AA-1d, AA-1sum (09-15), AA-1cert (proposed) (completed), AA-1sum (proposed) (all possible), AA-1sum (proposed) (completed), AA-1 (proposed), AA-1 (07-15), AA-1cert, AA-1d, AA-1cert (proposed) (all possible)	Application for Employee Annuity ,   Application for Determination of Employee Disability ,   Application for Employee Annuity ,   Application Summary and Certification ,   Application Summary and Certification ,   Application Summary and Certification ,   Application Summary ,   Application Summary ,   Application Summary ,   Application for Determination of Employee Disability
Application for Employee Annuity Under the Railroad Retirement Act	RRB Form G-204	Verification of Worker's Compensation/Public Disability

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	15,345	17,825	0	0	-2,480	0
Annual Time Burden (Hours)	8,892	9,119	0	0	-227	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The burden for this collection has been reduced largely due to the change in the estimate of the amount of responses annual responses due to enhanced RRB internal reporting/tracking capabilities as well as increased estimated completion times for Form AA-1d.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/29/2016

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