Information Collection

Employee Non-Covered Service Pension Questionnaire

IC 33954 under ICR 202406-3220-006 · OMB 3220-0154.

Documents and Forms

Document Name Document Type
Form G-209 Employee Non-Covered Service Pension Questionnaire Form and Instruction
G-209 Employee Non-Covered Service Pension Questionnaire Form G-209 (05-17).pdf Form and Instruction
G-209 Employee Non-Covered Service Pension Questionnaire Form G-209 (05-17).pdf Form and Instruction
Form SSA-150 (10-2014).pdf Modified Benefit Formula Questionnaire IC Document
Form SSA-150 (10-2014).pdf Modified Benefit Formula Questionnaire IC Document
Form RL-1 (xx-xx).pdf Transmittal Letter - (Proposed) IC Document
Form RL-1 (xx-xx).pdf Transmittal Letter - (Proposed) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Employee Non-Covered Service Pension Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	G-209	Employee Non-Covered Service Pension Questionnaire	Form G-209 (05-17).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: RRB-22, Railroad Retirement, Survivor, and Pensioner Benefit Sytem	FR Citation: 79 FR 58874

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	14	14
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Modified Benefit Formula Questionnaire	Form SSA-150 (10-2014).pdf	12/09/2020
Transmittal Letter - (Proposed)	Form RL-1 (xx-xx).pdf	06/25/2024

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