Earnings Information Request

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0184 can be found here:

Documents and Forms

Document Name Document Type
Form G-19F (03-16) Earnings Information Request Form and Instruction
G-19F (03-16) Earnings Information Request Form G-19F (03-16).pdf Form and Instruction
Form G-19F (Web) ( Earnings Information Request Form G-19F (Web) (Proposed).pdf Form and Instruction
Form G-254 (01-16).pdf G-254; Continuing Disability Report IC Document
Form G-19L (08-12).pdf G-19L; Annual Earnings Questionnaire IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Earnings Information Request	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 230

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	G-19F (03-16)	Earnings Information Request	Form G-19F (03-16).pdf		No		Paper Only
Form and Instruction	Form G-19F (Web) (Proposed)	Earnings Information Request	Form G-19F (Web) (Proposed).pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: RRB-22; Railroad Retirement, Survivor and Pension Benefit System	FR Citation: 79 FR 58874

Number of Respondents: 900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
G-254; Continuing Disability Report	Form G-254 (01-16).pdf	02/14/2017
G-19L; Annual Earnings Questionnaire	Form G-19L (08-12).pdf	02/15/2014

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