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AA-12 Notice of Death and Statement of Compensation
Employer Reporting
OMB: 3220-0005
IC ID: 45663
OMB.report
RRB
OMB 3220-0005
ICR 202209-3220-001
IC 45663
( )
Documents and Forms
Document Name
Document Type
Form AA-12 (01-19)
AA-12 Notice of Death and Statement of Compensation
Form
AA-12 (01-19) Notice of Death and Request for Service Needed for Eligibility
Form AA-12 (01-19).pdf
www.rrb.gov/sites/default/files/2019-01/AA-12%20(01-19).pdf
Form
Information Collection (IC) Details
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