AA-12 Notice of Death and Statement of Compensation

Employer Reporting

OMB: 3220-0005

IC ID: 45663

Information Collection (IC) Details

View Information Collection (IC)

AA-12 Notice of Death and Statement of Compensation
No Unchanged
20 CFR 209.6

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form AA-12 (01-19) Notice of Death and Request for Service Needed for Eligibility Form AA-12 (01-19).pdf https://www.rrb.gov/sites/default/files/2019-01/AA-12%20(01-19).pdf Yes No Printable Only

Income Security Survivor Compensation

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

579 0
Private Sector Businesses or other for-profits
   0 %

  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 60 0 0 0 0 60
Annual IC Time Burden (Hours) 5 0 0 0 0 5
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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