Information Collection

Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment

IC 33989 under ICR 202106-3220-005 · OMB 3220-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0179 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-19L Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment	Form
G-19L Annual Earnings Questionnaire Form G-19L (02-18).pdf	Form
G-19L Annual Earnings Questionnaire Form G-19L (02-18).pdf	Form

IC Title:

Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment

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 230.2 20 CFR 230.1

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	G-19L	Annual Earnings Questionnaire	Form G-19L (02-18).pdf		No		Paper Only

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: 300

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	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	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.