Application for Survivor Death Benefits

ICR 202204-3220-002

OMB: 3220-0031

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Supporting Statement A
2022-04-21
Supplementary Document
2019-03-18
ICR Details
3220-0031 202204-3220-002
Received in OIRA 201812-3220-001
RRB
Application for Survivor Death Benefits
Revision of a currently approved collection   No
Regular 04/29/2022
  Requested Previously Approved
36 Months From Approved 05/31/2022
7,800 7,800
1,975 1,975
0 0

The collection obtains the information needed to pay death benefits and annuities due but unpaid at death under the Railroad Retirement Act. Benefits are paid to designated beneficiaries or to survivors in a priority designated by law.

US Code: 45 USC 231(f) et seq Name of Law: Railroad Retirement Act
  
None

Not associated with rulemaking

  87 FR 8619 02/15/2022
87 FR 25058 04/27/2022
No

  Total Request 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 7,800 7,800 0 0 0 0
Annual Time Burden (Hours) 1,975 1,975 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
    Yes
    Yes
No
No
No
No
Brian Foster 312 751-4826 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/29/2022


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