Survivor Questionnaire

ICR 201603-3220-001

OMB: 3220-0032

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2016-03-21
IC Document Collections
IC ID
Document
Title
Status
33842 Modified
ICR Details
3220-0032 201603-3220-001
Historical Active 201211-3220-001
RRB
Survivor Questionnaire
Revision of a currently approved collection   No
Regular
Approved without change 04/27/2016
Retrieve Notice of Action (NOA) 03/21/2016
  Inventory as of this Action Requested Previously Approved
04/30/2019 36 Months From Approved 04/30/2016
8,000 0 8,000
1,391 0 1,391
0 0 0

Under Section 6 of the Railroad Retirement Act, benefits are payable to the survivors or the estates of deceased railroad employees. The collection obtains information used to determine if and to whom benefits are payable; such as a widow(er) due survivor benefits, an executor of the estate, or a payer of burial expenses.

US Code: 45 USC 231(f) et seq. Name of Law: Railroad Retirement Act
  
None

Not associated with rulemaking

  80 FR 81383 12/29/2015
81 FR 14141 03/16/2016
No

1
IC Title Form No. Form Name
Survivor Questionnaire RL-94F (03-13), RL-94F (proposed) Survivor Questionnaire ,   Survivor Questionnaire

  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 8,000 8,000 0 0 0 0
Annual Time Burden (Hours) 1,391 1,391 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
Yes
No
No
No
Uncollected
Charles Mierzwa 312-751-3363 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/21/2016


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