Information Collection

Application for Employee Annuity Under the Railroad Retirement Act

IC 33796 under ICR 202012-3220-001 · OMB 3220-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AA-1d Application for Employee Annuity Under the Railroad Retirement Act	Form and Instruction
AA-1 Application for Employee Annuity Form AA-1 (01-18).pdf	Form and Instruction
AA-1 Application for Employee Annuity Form AA-1 (01-18).pdf	Form and Instruction
AA-1d Application for Determination of Employee Disability Form AA-1D (05-17).pdf	Form and Instruction
AA-1d Application for Determination of Employee Disability Form AA-1D (05-17).pdf	Form and Instruction
AA-1cert (12-17) ( Application Summary and Certification Form AA-1cert (12-17) All Possible.pdf	Form
AA-1cert (12-17) ( Application Summary and Certification Form AA-1cert (12-17) All Possible.pdf	Form
AA-1cert (12-17) ( Application Summary and Certification Form AA-1cert (12-17) Completed.pdf	Form
AA-1cert (12-17) ( Application Summary and Certification Form AA-1cert (12-17) Completed.pdf	Form
AA-1sum (12-17) (A Application Summary Form AA-1sum (12-17) All Possible.pdf	Form
AA-1sum (12-17) (A Application Summary Form AA-1sum (12-17) All Possible.pdf	Form
AA-1sum (12-17) (C Application Summary Form AA-1sum (12-17) Completed.pdf	Form
AA-1sum (12-17) (C Application Summary Form AA-1sum (12-17) Completed.pdf	Form
AA-1d Application for Determination of Employee Disability Form AA-1D (xx-xx) - Proposed.pdf	Form and Instruction
AA-1d Application for Determination of Employee Disability Form AA-1D (xx-xx) - Proposed.pdf	Form and Instruction
AA-1 (Internet) Application for Employee Annuity Form AA-1 (Internet) (Current).pdf	Form and Instruction
AA-1 (Internet) Application for Employee Annuity Form AA-1 (Internet) (Current).pdf	Form and Instruction
Form G-3EMP (08-15).pdf Report of Medical Condition by Employer	IC Document
Form G-3EMP (08-15).pdf Report of Medical Condition by Employer	IC Document
Form G-250 (08-15).pdf Medical Assessment	IC Document
Form G-250 (08-15).pdf Medical Assessment	IC Document
Form RL-250 (09-05).pdf Request for Medical Assessment	IC Document
Form RL-250 (09-05).pdf Request for Medical Assessment	IC Document
Form G-209 (05-17).pdf Employee Non-Covered Service Person Questionnaire	IC Document
Form G-209 (05-17).pdf Employee Non-Covered Service Person Questionnaire	IC Document
Form G-88P (12-17).pdf Supplemental Pension Report	IC Document
Form G-88P (12-17).pdf Supplemental Pension Report	IC Document
AA-6 (01-12).pdf Employee Application for Medicare	IC Document
AA-6 (01-12).pdf Employee Application for Medicare	IC Document
Form RL-1 (08-18).pdf Transmittal Letter	IC Document
Form RL-1 (08-18).pdf Transmittal Letter	IC Document
Form AA-1int (12-17) All Possible.pdf Receipt for Claim	IC Document
Form AA-1int (12-17) All Possible.pdf Receipt for Claim	IC Document
Form AA-1int (12-17) Completed.pdf Receipt for Claim	IC Document
Form AA-1int (12-17) Completed.pdf Receipt for Claim	IC Document
RB-9 (07-19).pdf Events the Affect Employee and Spouse Annuities	IC Document
RB-9 (07-19).pdf Events the Affect Employee and Spouse Annuities	IC Document
G-77a (11-20).pdf How Work Affects You Railroad Benefits	IC Document
G-77a (11-20).pdf How Work Affects You Railroad Benefits	IC Document
RB-1 (05-18).pdf Age and Service Employee Annuity	IC Document
RB-1 (05-18).pdf Age and Service Employee Annuity	IC Document
Form AA-6 (01-12).pdf Employee Application for Medicare	IC Document
Form AA-6 (01-12).pdf Employee Application for Medicare	IC Document
Form RL-11B (09-05).pdf Transmittal Letter	IC Document
Form RL-11B (09-05).pdf Transmittal Letter	IC Document
Form G-251 (03-17).pdf Vocational Report	IC Document
Form G-251 (03-17).pdf Vocational Report	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Application for Employee 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 220 20 CFR 216

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-1	Application for Employee Annuity	Form AA-1 (01-18).pdf	No		Paper Only
Form and Instruction	AA-1d	Application for Determination of Employee Disability	Form AA-1D (05-17).pdf	No		Paper Only
Form	AA-1cert (12-17) (All Possible)	Application Summary and Certification	Form AA-1cert (12-17) All Possible.pdf	Yes	Yes	Fillable Printable
Form	AA-1cert (12-17) (Completed)	Application Summary and Certification	Form AA-1cert (12-17) Completed.pdf	Yes	Yes	Fillable Printable
Form	AA-1sum (12-17) (All Possible)	Application Summary	Form AA-1sum (12-17) All Possible.pdf	Yes	Yes	Fillable Printable
Form	AA-1sum (12-17) (Completed)	Application Summary	Form AA-1sum (12-17) Completed.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AA-1d	Application for Determination of Employee Disability	Form AA-1D (xx-xx) - Proposed.pdf	No		Paper Only
Form and Instruction	AA-1 (Internet)	Application for Employee Annuity	Form AA-1 (Internet) (Current).pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

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

FR Citation: 79 FR 58874

Number of Respondents: 12,720

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 83 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	15,325	0	15,325
Annual IC Time Burden (Hours)	9,749	-1	9,750
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Report of Medical Condition by Employer	Form G-3EMP (08-15).pdf	12/09/2020
Medical Assessment	Form G-250 (08-15).pdf	12/09/2020
Request for Medical Assessment	Form RL-250 (09-05).pdf	12/09/2020
Employee Non-Covered Service Person Questionnaire	Form G-209 (05-17).pdf	12/09/2020
Supplemental Pension Report	Form G-88P (12-17).pdf	12/09/2020
Employee Application for Medicare	AA-6 (01-12).pdf	12/09/2020
Transmittal Letter	Form RL-1 (08-18).pdf	12/09/2020
Receipt for Claim	Form AA-1int (12-17) All Possible.pdf	12/09/2020
Receipt for Claim	Form AA-1int (12-17) Completed.pdf	12/09/2020
Events the Affect Employee and Spouse Annuities	RB-9 (07-19).pdf	12/10/2020
How Work Affects You Railroad Benefits	G-77a (11-20).pdf	12/10/2020
Age and Service Employee Annuity	RB-1 (05-18).pdf	12/10/2020
Employee Application for Medicare	Form AA-6 (01-12).pdf	12/10/2020
Transmittal Letter	Form RL-11B (09-05).pdf	12/10/2020
Vocational Report	Form G-251 (03-17).pdf	12/10/2020

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