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 (Internet) Application for Employee Annuity	Form and Instruction	Modified	Available
Form AA-1d Application for Determination of Employee Disability	Form and Instruction	Modified	Available
Form AA-1d Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified	Missing upstream
Form AA-1sum (12-17) (C Application Summary	Form	Modified	Available
Form AA-1sum (12-17) (A Application Summary	Form	Modified	Available
Form AA-1cert (12-17) ( Application Summary and Certification	Form	Modified	Available
Form AA-1cert (12-17) ( Application Summary and Certification	Form	Modified	Available
Form AA-1d Application for Determination of Employee Disability	Form and Instruction	Modified	Available
Form AA-1 Application for Employee Annuity	Form and Instruction	Modified	Available
Form G-204 (xx-xx) - Pr Verification of Workers Compensation/Public Disability	Form and Instruction	Modified	Available
Form G-204 (xx-xx) - Pr Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified	Repair queued
Form RRB Form G-204 Verification of Worker's Compensation/Public Disability	Form and Instruction	Modified	Available
3220-0002.docx	Supporting Statement A	Uploaded 2020-12-10	Repair queued

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	Application for Employee Annuity
33796	Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified	Application for Determination of Employee Disability
33796	Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified
33796	Application for Employee Annuity Under the Railroad Retirement Act	Form	Modified	Application Summary
33796	Application for Employee Annuity Under the Railroad Retirement Act	Form	Modified	Application Summary
33796	Application for Employee Annuity Under the Railroad Retirement Act	Form	Modified	Application Summary and Certification
33796	Application for Employee Annuity Under the Railroad Retirement Act	Form	Modified	Application Summary and Certification
33796	Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified	Application for Determination of Employee Disability
33796	Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified	Application for Employee Annuity
178327	Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction	Modified	Verification of Workers Compensation/Public Disability
178327	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	Verification of Worker's Compensation/Public Disability

ICR Details

OMB Control No: 3220-0002	ICR Reference No: 202012-3220-001
Status: Historical Active	Previous ICR Reference No: 201711-3220-001
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: 07/16/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/10/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2024	36 Months From Approved	07/31/2021
Responses	15,345	0	15,345
Time Burden (Hours)	9,754	0	9,755
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:
	85 FR 62775	10/05/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 79536	12/10/2020
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	G-204 (xx-xx) - Proposed, RRB Form G-204	Verification of Worker's Compensation/Public Disability ,   Verification of Workers Compensation/Public Disability
Application for Employee Annuity Under the Railroad Retirement Act	AA-1d, AA-1sum (12-17) (Completed), AA-1, AA-1d, AA-1cert (12-17) (All Possible) , AA-1cert (12-17) (Completed), AA-1 (Internet), AA-1sum (12-17) (All Possible)	Application for Employee Annuity ,   Application for Determination of Employee Disability ,   Application Summary and Certification ,   Application Summary and Certification ,   Application Summary ,   Application Summary ,   Application for Determination of Employee Disability ,   Application for Employee Annuity

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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)	9,754	9,755	0	-1	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The burden hours decrease in ROCIS by 1, from 9, 755 to 9,754, due to a correction to the total burden hours. The burden hours for the first ICR in ROCIS (Form’s AA-1, AA-1cert, AA-1sum, AA-1 (Internet), and AA-1d) should be 9,749 instead of 9,750.

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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? 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: 12/10/2020

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