3220-0202

OMB No. 3220-0202

Justification

Self-Employment/Corporate Officer Work and Earnings Monitoring

RRB Form G-252

1. Circumstances of information collection – Section 2 of the Railroad Retirement Act (RRA) provides for the payment of age and service, disability, and supplemental annuities to qualified employees. After an annuitant begins receiving an annuity, Section 2 also provides that an annuity is not payable or is reduced for any month in which the annuitant works for a railroad or earns more than prescribed dollar amounts from either nonrailroad employment or self-employment. Certain types of work may indicate an annuitant's recovery from disability. The provisions relating to the reduction or nonpayment of annuities by reason of work and an annuitant's recovery from disability for work are prescribed in 20 CFR 220.17-220.20.

Some activities claimed by the applicant as “self-employment” may actually be employment for someone else (e.g., training officer, consultant, salesman). An applicant is not self-employed if working in an incorporated business since the corporation is the applicant’s employer. These requirements are described in 20 CFR 216.

In addition, the Railroad Retirement Board (RRB) conducts continuing disability reviews (also known as a CDR) to determine whether the annuitant continues to meet the disability requirements of the law. Payment of disability benefits and/or a beneficiary’s period of disability will end if medical evidence or other information shows that an annuitant is not disabled under the standards prescribed in section 2 of the RRA. Continuing disability reviews are generally conducted if (1) the annuitant is scheduled for a routine periodic review, (2) the annuitant returns to work and successfully completes a trial work period, (3) substantial earnings are posted to the annuitant’s wage record or (4) information is received from the annuitant or a reliable source that the annuitant has recovered or returned to work. Provisions relating to when and how often the RRB conducts disability reviews are prescribed in 20 CFR 220.186.

2. Purposes of collecting/consequences of not collecting the information - The RRB utilizes Form G-252, Self-Employment/Corporate Officer Work and Earnings Monitoring, to determine entitlement or continued entitlement to a disability annuity. The RRB obtains information from disability annuitants who claim to be self-employed or a corporate officer or who the RRB determines to be self-employed or a corporate officer after a continuing disability review. Form G-252, is a supplemental form to the AA-4, Self-Employment Application (OMB No. 3220-0138), and obtains additional information from an annuitant who claimed to be self-employed or to be a corporate officer on Form AA-4. It also is used with initial disability applications, early Medicare applications, applications for a period of disability (disability freeze), as well as continuing disability review determinations, including determinations prompted by a report of work, return to railroad service, allegations of medical improvement, or routine disability review call‑up. The information collected is used to determine initial/continuing entitlement to, and the amount of, the annuity.

Form G-252 is self-administered. An RRB office releases the form to the applicant. Instructions for completing and returning the form are provided on Form RL‑252, Cover Letter for Form G‑252, which is mailed with the Form G‑252. The applicant is required to return the completed form to RRB headquarters in the pre-addressed envelope provided for that purpose.

The RRB proposes no changes to Form G-252.

3. Planned use of improved information technology or technical/legal impediments to further burden reduction – Internet processing is not planned at this time due to low usage. Future development will be subject to technology and budgetary constraints.

4. Efforts to identify duplication – This information collection does not duplicate any other RRB information collection.

5. Small business respondents – N.A.

6. Consequences of less frequent collection – N.A.

7. Special Circumstances – None

8. Public Comments/consultations outside the agency – In accordance with 5 CFR 1320.8(d), comments were invited from the public regarding the information collection. The notice to the public was published on page 9250 of the February 3, 2017, Federal Register. No requests for further information or comments were received.

9. Payments or gifts to respondents – None

10. Confidentiality – Privacy Act System of Records, RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System. An RRB Privacy Impact Assessment that includes RRB-22 can be found at the following link: http://www.rrb.gov/pdf/PIA/PIA-BPO.pdf.

11. Sensitive questions – N.A.

12. Estimate of respondent burden - The current estimated annual burden for this collection is unchanged:

Current Burden

Form Number	Annual Responses	Time (Minutes)	Burden (Hours)
G-252	100	20	33
Total	100		33

13. Estimated costs to respondents or record keepers – N/A

14. Estimated cost to the Federal Government – N/A

15. Explanation for change in burden – N/A

16. Time schedule for data collection and publication – The results of this collection will not be published.

17. Request not to display OMB expiration date - Form G-252 is seldom revised. Given the costs associated with programming, redrafting, reprinting, and distribution of the form in order to keep the appropriate OMB expiration date on the form, the RRB requests the authority not to display the OMB expiration date on the forms.

18. Exceptions to Certification Statement - None.

-3-