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Repayment by Credit Card
Repayment of Debt
OMB: 3220-0169
IC ID: 33968
OMB.report
RRB
OMB 3220-0169
ICR 202303-3220-005
IC 33968
( )
Documents and Forms
Document Name
Document Type
Form G-421F (04-20)
Repayment by Credit Card
Form
G-421F (04-20) Repayment by Debit Card - (Current)
Form G-421F (04-20).pdf
Form
G-421F (04-20) Repayment by Debit Card - (Current)
Form G-421F (04-20).pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Repayment by Credit Card
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
20 CFR 255
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
G-421F (04-20)
Repayment by Debit Card - (Current)
Form G-421F (04-20).pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
RRB- 21, Railroad Retirement Survivor and Pensioner Benefit System
FR Citation:
79 FR 58874
Number of Respondents:
360
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
360
0
0
0
0
360
Annual IC Time Burden (Hours)
30
0
0
0
0
30
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.
