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Financial Disclosure Statement
Financial Disclosure Statement
OMB: 3220-0127
IC ID: 33919
OMB.report
RRB
OMB 3220-0127
ICR 202405-3220-002
IC 33919
( )
Documents and Forms
Document Name
Document Type
Form DR-423 (04-17)
Financial Disclosure Statement
Form and Instruction
DR-423 (04-17) Financial Disclosure Statement
Form DR-423 (04-17).pdf
Form and Instruction
DR-423 (04-17) Financial Disclosure Statement
Form DR-423 (04-17).pdf
Form and Instruction
Form RL-423 (09-05).pdf
Request DR-423 For Waiver of Overpayment
IC Document
Form RL-423 (09-05).pdf
Request DR-423 For Waiver of Overpayment
IC Document
SSA-632BK (08-2019).pdf
Request for Waiver of Overpayment Recovery
IC Document
SSA-632BK (08-2019).pdf
Request for Waiver of Overpayment Recovery
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Financial Disclosure Statement
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
20 CFR 255
20 CFR 340
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
DR-423 (04-17)
Financial Disclosure Statement
Form DR-423 (04-17).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-22, Railroad Retirement, Survivor, and Pensioner Benefit System
FR Citation:
79 FR 58874
Number of Respondents:
1,200
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
1,200
0
0
0
0
1,200
Annual IC Time Burden (Hours)
1,700
0
0
0
0
1,700
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Request DR-423 For Waiver of Overpayment
Form RL-423 (09-05).pdf
06/17/2014
Request for Waiver of Overpayment Recovery
SSA-632BK (08-2019).pdf
11/23/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.