Employer's Deemed Service Month Questionnaire

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0156 can be found here:

Documents and Forms

Document Name Document Type
Form GL-99 (04-13) Employer's Deemed Service Month Questionnaire Form and Instruction
GL-99 (04-13) Employer's Deemed Service Months Questionnaire Form GL-99 (04-13).pdf Form and Instruction
GL-99 (proposed) Employer's Deemed Service Month Questionnairre Form GL-99 (Proposed).pdf Form and Instruction
Employer Reporting Instructions.pdf Employer Reporting Instructions IC Document
BA-3 (Internet) (01-12).pdf Form BA-3, Annual Report of Creditable Compensation IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Employer's Deemed Service Month Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 210

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	GL-99 (04-13)	Employer's Deemed Service Months Questionnaire	Form GL-99 (04-13).pdf		No		Paper Only
Form and Instruction	GL-99 (proposed)	Employer's Deemed Service Month Questionnairre	Form GL-99 (Proposed).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: RRB-5, Master File of Railroad Employees Service and Compensation	FR Citation: 79 FR 58874

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,000	-2,000	4,000
Annual IC Time Burden (Hours)	67	-66	133
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Employer Reporting Instructions	Employer Reporting Instructions.pdf	03/08/2016
Form BA-3, Annual Report of Creditable Compensation	BA-3 (Internet) (01-12).pdf	03/21/2016

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