Information Collection

Application for Employee Annuity Under the Railroad Retirement Act

IC 178327 under ICR 201605-3220-001 · OMB 3220-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RRB Form G-204 Verification of Worker's Compensation/Public Disability Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction
RRB Form G-204 Verification of Worker's Compensation/Public Disability Form G-204 (11-02).pdf	Form and Instruction

IC Title:

Application for Employee Annuity Under the Railroad Retirement Act

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 216 20 CFR 220

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 and Instruction	RRB Form G-204				No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

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

FR Citation: 79 FR 58874

Number of Respondents: 20

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	20	20
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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