Information Collection

Application for Spouse Annuity Under the Railroad Retirement Act

IC 33861 under ICR 201812-3220-004 · OMB 3220-0042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0042 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AA-3cert (all poss Application for Spouse Annuity Under the Railroad Retirement Act	Form and Instruction
AA-3cert (all poss Application Summary and Certification Form AA-3cert (04-13) All possible.pdf	Form and Instruction
AA-3cert (complete Application Summary and Certification Form AA-3cert (04-13) Completed - Generic Info.pdf	Form
AA-3sum (all possi Application Summary Form AA-3sum (11-14) All Possible.pdf	Form
AA-3sum (completed Application Summary Form AA-3sum (11-14) Completed - Generic Info.pdf	Form
Form RB-3 (11-08).pdf RB-3, Furnishing Evidence To Support Your Claim	IC Document
Form RB-30 (04-16).pdf RB-30, Spouse/Divorced Spouse Annuity	IC Document
Form RB-9 (05-16).pdf RB-9, Employee and Spouse Annuities - Events That Must Be Reported	IC Document
Form AA-7 (01-12).pdf AA-7, Spouse/Divorced Application for Medicare	IC Document
Form G-208 (02-17).pdf G-208, Public Service Pension Questionnaire	IC Document
Form AA-3 (07-17).pdf AA-3, Application for Spouse/Divorced Spouse Annuity	IC Document
Form AA-3rec (04-13).pdf AA-3rec, Receipt for Claim	IC Document
Form RL-1 (08-18).pdf RL-1	IC Document
Form G-77a (11-18).pdf G-77a (11-18)	IC Document

IC Title:

Application for Spouse 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 218.11 20 CFR 216.50

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	AA-3cert (all possible)	Application Summary and Certification	Form AA-3cert (04-13) All possible.pdf	Yes	Yes	Fillable Printable
Form	AA-3cert (completed)	Application Summary and Certification	Form AA-3cert (04-13) Completed - Generic Info.pdf	Yes	Yes	Fillable Printable
Form	AA-3sum (all possible)	Application Summary	Form AA-3sum (11-14) All Possible.pdf	Yes	Yes	Fillable Printable
Form	AA-3sum (completed)	Application Summary	Form AA-3sum (11-14) Completed - Generic Info.pdf	Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records

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

FR Citation: 79 FR 58874

Number of Respondents: 11,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	11,000	-700	11,700
Annual IC Time Burden (Hours)	5,423	-310	5,733
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
RB-3, Furnishing Evidence To Support Your Claim	Form RB-3 (11-08).pdf	02/25/2010
RB-30, Spouse/Divorced Spouse Annuity	Form RB-30 (04-16).pdf	12/21/2018
RB-9, Employee and Spouse Annuities - Events That Must Be Reported	Form RB-9 (05-16).pdf	12/21/2018
AA-7, Spouse/Divorced Application for Medicare	Form AA-7 (01-12).pdf	12/05/2012
G-208, Public Service Pension Questionnaire	Form G-208 (02-17).pdf	12/21/2018
AA-3, Application for Spouse/Divorced Spouse Annuity	Form AA-3 (07-17).pdf	12/21/2018
AA-3rec, Receipt for Claim	Form AA-3rec (04-13).pdf	12/21/2018
RL-1	Form RL-1 (08-18).pdf	03/01/2019
G-77a (11-18)	Form G-77a (11-18).pdf	03/01/2019

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