Information Collection

Survivor Questionnaire

IC 33842 under ICR 201902-3220-003 · OMB 3220-0032.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0032 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RL-94F (10-18) Survivor Questionnaire	Form and Instruction
RL-94F (10-18) Survivor Questionnaire RL-94F (10-18).pdf	Form and Instruction

IC Title:

Survivor Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 234

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	RL-94F (10-18)	Survivor Questionnaire	RL-94F (10-18).pdf		No		Paper Only

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: 5,450

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,450	-2,550	8,000
Annual IC Time Burden (Hours)	959	-432	1,391
Annual IC Cost Burden (Dollars)	0	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.