Information Collection

Employer's Deemed Service Month Questionnaire

IC 44219 under ICR 201902-3220-004 · OMB 3220-0156.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0156 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form GL-99 (10-18) Employer's Deemed Service Month Questionnaire	Form and Instruction
GL-99 (10-18) Employer's Deemed Service Months Questionnaire Form GL-99 (10-18).pdf	Form and Instruction
Employer Reporting Instructions (02-19).pdf Employer Reporting Instructions	IC Document
BA-3 (Internet) (01-12).pdf Form BA-3, Annual Report of Creditable Compensation	IC Document

IC Title:

Employer's Deemed Service Month Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 210

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	GL-99 (10-18)	Employer's Deemed Service Months Questionnaire	Form GL-99 (10-18).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: RRB-5, Master File of Railroad Employees Service and Compensation

FR Citation: 79 FR 58874

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Employer Reporting Instructions	Employer Reporting Instructions (02-19).pdf	02/27/2019
Form BA-3, Annual Report of Creditable Compensation	BA-3 (Internet) (01-12).pdf	03/21/2016

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