Application for Employee Annuity Under the Railroad Retirement Act

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form AA-1 Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified	Available
Form RRB Form G-204 Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified	Available
3220-0002.doc	Supporting Statement A	Uploaded 2017-11-22	Available
RB-1D-1 (07-16).pdf	Supplementary Document	Uploaded 2017-11-21	Available
Form RL-250 (09-05).pdf	Supplementary Document	Uploaded 2017-11-21	Available
Form AA-1rec (03-16).pdf	Supplementary Document	Uploaded 2016-09-22	Available
Form RL-11b (09-05).pdf	Supplementary Document	Uploaded 2000-07-01	Available
Form RL-1 (04-07).pdf	Supplementary Document	Uploaded 2010-03-24	Available
RB-9 (05-16).pdf	Supplementary Document	Uploaded 2017-11-21	Available
RB-3 (11-08) .pdf	Supplementary Document	Uploaded 2017-11-21	Available
RB-1D (03-09).pdf	Supplementary Document	Uploaded 2017-11-21	Available
RB-1 (9-17).pdf	Supplementary Document	Uploaded 2017-11-21	Available
Form G-251 (03-17).pdf	Supplementary Document	Uploaded 2017-11-21	Available
Form G-250 (08-15).pdf	Supplementary Document	Uploaded 2016-02-29	Available
Form G-209 (05-17).pdf	Supplementary Document	Uploaded 2017-11-21	Available
Form G-77a (11-16).pdf	Supplementary Document	Uploaded 2017-11-21	Available
Form G-19F (03-16).pdf	Supplementary Document	Uploaded 2016-09-22	Available
Form G-3EMP (08-15).pdf	Supplementary Document	Uploaded 2016-02-29	Available
Form G-88p (10-14).pdf	Supplementary Document	Uploaded 2017-11-21	Available
Form AA-5 (09-15).pdf	Supplementary Document	Uploaded 2016-09-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
33796	Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified
178327	Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified

ICR Details

OMB Control No: 3220-0002	ICR Reference No: 201711-3220-001
Status: Active	Previous ICR Reference No: 201605-3220-001
Agency/Subagency: RRB	Agency Tracking No:
Title: Application for Employee Annuity Under the Railroad Retirement Act
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/29/2017
	Date Received in OIRA: 11/22/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2020	36 Months From Approved	12/31/2019
Responses	15,345	0	15,345
Time Burden (Hours)	9,755	0	8,892
Cost Burden (Dollars)	0	0	0

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Abstract: The Railroad Retirement Act provides for payment of age, disability and supplemental annuities to qualified employees. The application and related forms obtain information about the applicant's family work history, military service, disability benefits from other government agencies and public or private pensions. The information is used to determine entitlement to and the amount of the annuity applied for.

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Authorizing Statute(s): US Code: 45 USC 231a Name of Law: Railroad Retirement Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 43415	09/15/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 55425	11/21/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Application for Employee Annuity Under the Railroad Retirement Act	AA-1sum, AA-1cert (Proposed) (Completed), AA-1sum (Proposed) (All Possible), AA-1sum (Proposed) (Completed), AA-1 (Proposed), AA-1, AA-1cert, AA-1d, AA-1cert (Proposed) (All Possible)	Application for Employee Annuity ,   Application for Determination of Employee Disability ,   Application for Employee Annuity ,   Application Summary and Certification ,   Application Summary and Certification ,   Application Summary and Certification ,   Application Summary ,   Application Summary ,   Application Summary
Application for Employee Annuity Under the Railroad Retirement Act	RRB Form G-204	Verification of Worker's Compensation/Public Disability

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ICR Summary of Burden

table that charts list of burden

	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	15,345	15,345	0	0	0	0
Annual Time Burden (Hours)	9,755	8,892	0	863	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The burden increase is due to the additional 45 minutes it will take to complete the proposed AA-1 (Internet).

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/22/2017

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