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Federal forms, ICRs, and supporting documents

Information Collection

Statement Regarding Contributions and Support

IC 33902 under ICR 202405-3220-001 · OMB 3220-0099.

Documents and Forms
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IC Document
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Information Collection (IC) Details

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Statement Regarding Contributions and Support
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 222.41(4) 20 CFR 216.81

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form G-134 Statement Regarding Contributions and Support Form G-134 (05-17).pdf No   Paper Only
Form G-134 (Proposed) Statement Regarding Contributions and Support Form G-134 (xx-xx) - PROPOSED.pdf No   Paper Only

Income Security General Retirement and Disability

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

15 0
   
Individuals or Households
 
   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 15 0 -85 0 0 100
Annual IC Time Burden (Hours) 39 0 -220 0 0 259
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Letter Requesting Applicant to Furnish Evidence Form RL-57A-F (10-82).pdf 09/14/2017
Notice of Information Needed in Claim under the RRA Form G-242 (01-07).pdf 09/14/2017
Support of Certificate SSA-760-F4.pdf 11/23/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.