3220-0032

OMB NO. 3220-0032

Justification

Survivor Questionnaire

RRB Form RL-94-F

1. Circumstances of information collection - Under Section 6 of the Railroad Retirement Act (RRA) (45 U.S.C. 231e), benefits that may be payable upon the death of a railroad employee or a survivor annuitant include (1) a lump-sum death benefit (2) a residual lump-sum payment (3) accrued annuities due but unpaid at death, and (4) monthly survivor insurance payments.

The requirements for determining the entitlement of possible beneficiaries to these benefits are prescribed in 20 CFR 234.

2. Purposes of collecting/consequences of not collecting the information - Form RL-94-F, Survivor Questionnaire, is used by a Railroad Retirement Board (RRB) field office after receiving notification of the death of a railroad employee or survivor annuitant, to obtain additional information needed to determine if benefits are payable under the RRA. This notification can be by means of a returned check, telephone call, or other sources such as the Social Security Administration (SSA), Veterans Affairs, or a funeral home. The information obtained by Form RL-94-F is used to determine:

• the railroad employee's insured status;

• beneficiaries eligible for survivor benefits; and

• beneficiaries of unpaid annuities and residual lump sums. Information relating to the employee's insured status is used to determine whether survivor applications should be filed with the RRB or SSA. The first page of Form RL-94-F serves as a transmittal letter and also contains instructions for the completion and return of the questionnaire to the RRB. The identifying information in Items 1-4 of the questionnaire is completed by the RRB field office before the form is released.

Form RL-94-F is completed in its entirety, or in part, depending on the following:

• In most cases, there is no surviving widow(er) living with the deceased railroad employee at the time of death, so the field office mails the form to the nearest surviving relative. If there is no known surviving relative, the field office mails the form to the last known address of the employee or survivor annuitant and addresses it to: “The Family or Friends of [the name of the deceased employee or survivor annuitant is inserted], Deceased. The form is completed by the respondent in its entirety (i.e., items 5-18).

• In other cases, there is a surviving widow(er), and only items 5-10 and 18 are completed.

• In still other cases, where the information is already available from RRB records only item 18 is completed.

After completing the form, it is returned to the RRB field office in the return envelope provided.

The RRB proposes a minor non-burden impacting editorial change to Form RL-94-F:

• On the cover letter in the second paragraph: The address of the Department of the Treasury was updated to reflect the current mailing address.

3. Planned use of improved information technology or technical/legal impediments to further burden reduction - RRB releases the RL-94F with pre-filled data. Due to agency technology limitations, this information collection does not allow for electronic submission as described in the Government Paperwork Elimination Act (GPEA). However, we will reevaluate electronic signatures after the completion of our IT Modernization project.

4. Efforts to identify duplication - To our knowledge, no other agency uses a form similar to Form RL-94 F and this information collection does not duplicate any other RRB information collection.

5. Small business respondents - N.A.

6. Consequences of less frequent collection - Not applicable since the form is completed only once for each instance of an employee or survivor annuitant death.

7. Special circumstances - N.A.

8. Consultations outside the agency - In accordance with 5 CFR 320.8(d), comments were invited from the public regarding the information collection. The notice to the public was published on page 42217 of July 14, 2022, Federal Register. No comments or requests for additional information were received.

9. Payments or gifts to Respondents - None

10. Confidentiality - Privacy Act System of Records RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System. In accordance with OMB Circular M-03-22, a Privacy Impact Assessment for this information collection was completed and can be found at https://www.rrb.gov/sites/default/files/2017-06/PIA-BPO.pdf.

11. Sensitive questions - N.A.

12. Estimate of respondent burden - The current and proposed estimated burdens for this collection is unchanged as follows:

Current Burden

Form Number	Annual Responses	Time (Minutes)1/	Burden (Hours)
RL-94-F Items 5-10, and 18	50	9	8
RL-94-F, Items 5-18	5,000	11	917
RL-94-F, Item 18 only	400	5	34
Total	5,450		959

1/ The RRB has been collecting the information on these forms since OMB approved the information collection. Based on a sampling done when the form was originally created, the office calculated the estimated time, which includes time for getting the needed data and reviewing the completed form.

13. Estimate of annual cost to respondents or record keepers - The burden hours of 959x20.30 (BLS hourly mean wage for Other Support Activities for Transportation”) = $19,467.70 annual cost to respondents.

14. Estimate of cost to Federal Government – The total amount of forms submitted annually is 5,450. The Form RL-94-F is submitted and scanned on the RRB imaging system at both our field office locations and headquarters equally at about 2,725. The HQ scanner is a GS-11 Step 6 and field offices are GS-5 Step 1. The hourly rate for a GS-11 Step 6 is $31.85 and a GS-5 Step 1 is $14.89. It takes 227 hours annually for each government employee to scan the Form RL-94-F. The total cost to federal government is 227x$31.85 + 227x$14.89 = $10,609.98.

15. Explanation for changes in burden – N.A.

16. Time schedule for data collection and publication - The results of this collection will not be published.

17. Request not to display OMB expiration date - The RRB started an extensive multi-year IT Modernization Initiative at the beginning of Fiscal Year 2019 to transform our operations into the 21^st Century using multiple contractor services to improve mission performance, expand service capabilities, and strengthen cybersecurity. We provided OMB with a consolidated project timeline.

Given that the forms in this collection are seldom revised; the costs associated with redrafting, reprinting, and distributing forms in order to keep the appropriate OMB expiration date in place; and our desire to reevaluate after the completion of the modernization project, the RRB requests the authority to not display the expiration date on the forms.

18. Exceptions to Certification Statement - None

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