Application for Survivor Death Benefits

Application for Survivor Death Benefits

OMB: 3220-0031

IC ID: 33838

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form
Form and Instruction
Form and Instruction
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Application for Survivor Death Benefits
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 234 20 CFR 217 20 CFR 219

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction AA-21 (12-18) Application for Lump-Sum Death Payments and Annuities Unpaid at Death Form AA-21 (12-18).pdf No   Paper Only
Form and Instruction G-131 (12-18) Authorization of Payment and Release of All Claims to a Death Benefit or Accrued Annuity Payment Form G-131 (12-18).pdf No   Paper Only
Form AA-21CERT (All Possible) Application Summary and Certification Form AA-21 Cert - (08-18) All Possible.pdf No   Paper Only
Form and Instruction AA-21 (Proposed) Application for Lump-Sum Death Payment and Annuities Unpaid at Death Form AA-21 (xx-xx) - Proposed.pdf No   Paper Only
Form AA-21CERT Completed Application Summary and Certification Form AA-21 Cert - (08-18) Completed.pdf No   Paper Only

Income Security Survivor Compensation

RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System  79 FR 58874

3,800 0
   
Individuals or Households
 
   92 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,800 0 0 0 0 3,800
Annual IC Time Burden (Hours) 1,308 0 0 0 0 1,308
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
AA-11a, Designation or Change of Beneficiary for Employees with Service Prior to January 1, 1975, for Residual Lump Sum Form AA-11a (12-18).pdf 03/18/2019
RB-21, Lump-Sum Death Payment, Residual Lump-Sum, Annuities Unpaid at Death Form RB-21 (10-18).pdf 03/18/2019
AA-21 - Application for Survivor Benefits - Receipt for Claim Form AA-21 Rec - (08-18) All Possible.pdf 04/22/2022
AA-21 - Application for Survivor Benefits - Receipt for Claim Form AA-21 Rec - (08-18) Completed.pdf 04/29/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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