Application for Survivor Insurance Annuities

ICR 202206-3220-002

OMB: 3220-0030

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2022-06-13
IC Document Collections
ICR Details
3220-0030 202206-3220-002
Received in OIRA 201812-3220-003
RRB
Application for Survivor Insurance Annuities
Extension without change of a currently approved collection   No
Regular 06/13/2022
  Requested Previously Approved
36 Months From Approved 06/30/2022
3,485 3,485
1,337 1,337
0 0

Under Section 2(d) of the Railroad Retirement Act, monthly survivor annuities are payable to surviving widow(er)s, parents, unmarried children, and in certain cases, divorced wives (husbands), mothers (fathers), remarried widow(er)s and grandchildren of deceased railroad employees. The collection obtains information needed by the RRB to determine entitlement to and the amount of the annuity applied for.

US Code: 45 USC 231f Name of Law: Railroad Retirement Act
  
None

Not associated with rulemaking

  87 FR 19538 04/04/2022
87 FR 35805 06/13/2022
No

1
IC Title Form No. Form Name
Application for Survivor Insurance Annuities AA-17cert (09-15)(all possible), AA-17b (10-07), AA-19a (10-07), AA-17cert (09-15), AA-17sum (01-19) (Completed), AA-17sum (01-19) (All possible) Application for Determination of Widow(ers) Disability ,   Application for Determination of Child's Disability ,   Application Summary and Certification ,   Application Summary and Certification ,   Application Summary ,   Application Summary

  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 3,485 3,485 0 0 0 0
Annual Time Burden (Hours) 1,337 1,337 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.
06/13/2022


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