Railroad Employment Questionnaire

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-671 Railroad Retirement Questionnaire	Form	Modified	Available
Supporting Statement - 0078.docx	Supporting Statement A	Uploaded 2020-08-07	Repair queued
Addendum - 0078.docx	Supplementary Document	Uploaded 2020-06-09	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9025	Railroad Employment Questionnaire	Form	Modified	Railroad Retirement Questionnaire
9025	Railroad Employment Questionnaire	Other-screens	Modified

ICR Details

OMB Control No: 0960-0078	ICR Reference No: 202004-0960-004
Status: Historical Active	Previous ICR Reference No: 201702-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Railroad Employment Questionnaire
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/01/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/07/2020
Terms of Clearance: The agency modified the Supporting Statement A to provide more clarity regarding the use of the information collection and updated the burden estimates.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2027	36 Months From Approved	04/30/2024
Responses	125,000	0	125,000
Time Burden (Hours)	122,917	0	10,417
Cost Burden (Dollars)	0	0	0

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Abstract: The Social Security Administration (SSA) coordinates with the Railroad Retirement Board (RRB) to provide an integrated system of benefits to railroad workers, their dependents, and their surviving family members. SSA uses form SSA-671, the Railroad Employment Questionnaire, to collect the information it needs to coordinate benefits with the RRB. The respondents are retiring or disabled railroad workers, their dependents, or their survivors.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security 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:
	85 FR 26776	05/05/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 45723	07/29/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Railroad Employment Questionnaire	SSA-671	Railroad Retirement Questionnaire

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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	125,000	125,000	0	0	0	0
Annual Time Burden (Hours)	122,917	10,417	0	0	112,500	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: There are no changes to the public reporting burden. * Note: The total burden reflected in ROCIS is 10,417, while the burden cited in #12 of the Supporting Statement is 122,917. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden

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Annual Cost to Federal Government: $1,553,925

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? No

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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: 08/07/2020

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