Survivor Questionnaire

ICR 202209-3220-002

OMB: 3220-0032

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2022-09-20
Supplementary Document
2019-09-26
Supplementary Document
2019-09-26
IC Document Collections
IC ID
Document
Title
Status
33842 Modified
ICR Details
3220-0032 202209-3220-002
Received in OIRA 201902-3220-003
RRB
Survivor Questionnaire
Revision of a currently approved collection   No
Regular 09/21/2022
  Requested Previously Approved
36 Months From Approved 09/30/2022
5,450 5,450
959 959
0 0

Under Section 6 of the Railroad Retirement Act, benefits are payable to the survivors or the estates of deceased railroad employees. The collection obtains information used to determine if and to whom benefits are payable; such as a widow(er) due survivor benefits, an executor of the estate, or a payer of burial expenses.

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

Not associated with rulemaking

  87 FR 42217 07/14/2022
87 FR 57526 09/20/2022
No

1
IC Title Form No. Form Name
Survivor Questionnaire RL-94F (XX-XX), RL-94F (10-18) Survivor Questionnaire ,   Survivor Questionnaire

  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 5,450 5,450 0 0 0 0
Annual Time Burden (Hours) 959 959 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$10,609
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.
09/21/2022


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