Information Collection

Earnings Information Request

IC 33996 under ICR 202405-3220-004 · OMB 3220-0184.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-19F (03-16) Earnings Information Request	Form and Instruction
Form G-19F (03-16) Earnings Information Request Earnings Information Request	Form and Instruction
Form Form G-19F (Web) Earnings Information Request Earnings Information Request	Form and Instruction
G-19F (03-16) Earnings Information Request Form G-19F (03-16).pdf	Form and Instruction
G-19F (03-16) Earnings Information Request Form G-19F (03-16).pdf	Form and Instruction
Form G-19F (Web) Earnings Information Request G-19F (Web).pdf	Form and Instruction
Form G-19F (Web) Earnings Information Request G-19F (Web).pdf	Form and Instruction
Form G-254 (08-17).pdf G-254; Continuing Disability Report	IC Document
Form G-254 (08-17).pdf G-254; Continuing Disability Report	IC Document
Form G-19L (08-12).pdf G-19L; Annual Earnings Questionnaire	IC Document
Form G-19L (08-12).pdf G-19L; Annual Earnings Questionnaire	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 230

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	G-19F (03-16)				No		Paper Only
Form and Instruction	Form G-19F (Web)				Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: RRB-22; Railroad Retirement, Survivor and Pension Benefit System

FR Citation: 79 FR 58874

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	700	-200	900
Annual IC Time Burden (Hours)	93	-27	120
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
G-254; Continuing Disability Report		05/16/2024
G-19L; Annual Earnings Questionnaire		02/15/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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