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Federal forms, ICRs, and supporting documents

Information Collection

Application for Survivor Insurance Annuities

IC 33834 under ICR 202411-3220-011 · OMB 3220-0030.

Documents and Forms
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Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form
Form
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Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
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Information Collection (IC) Details

View Information Collection (IC)

Application for Survivor Insurance Annuities
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 216 20 CFR 218 20 CFR 219 20 CFR 217

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction AA-17b (10-07) Application for Determination of Widow(ers) Disability AA-17b (06-19) CURRENT.pdf No   Paper Only
Form and Instruction AA-19a (10-07) Application for Determination of Child's Disability AA-19a(06-19) CURRENT.pdf No   Paper Only
Form AA-17cert (09-15)(all possible) Application Summary and Certification Form AA-17cert (09-15) (All Possible).pdf Yes Yes Printable Only
Form AA-17cert (09-15) Application Summary and Certification Form AA-17cert (09-15) (Completed).pdf Yes Yes Printable Only
Form AA-17sum (01-19) (All possible) Application Summary Form AA-17sum (01-19) (All Possible).pdf Yes Yes Printable Only
Form AA-17sum (01-19) (Completed) Application Summary Form AA-17sum (01-19) (Completed).pdf Yes Yes Printable Only
Form and Instruction AA-17b (XX-XX) - Proposed Application for Determination of Widow(ers) Disability AA-17b (xx-xx) Proposed.pdf No   Paper Only
Form and Instruction AA-19a (XX-XX) - Proposed Application for Determination of Child's Disability AA-19a (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

3,410 0
   
Individuals or Households
 
   86 %

  Requested 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 3,410 0 0 -75 0 3,485
Annual IC Time Burden (Hours) 1,314 0 0 -23 0 1,337
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
RB-3 Booklet; Furnishing Evidence to Support Your Claim RB-3 (11-08).pdf 07/16/2009
RB-17 Booklet, Survivor Annuities RB-17 (03-19).pdf 06/13/2022
RB-17b Booklet; Widow(ers) Disability Benefits RB-17b (03-19).pdf 03/15/2019
RB-19A Booklet; Child's Disability Benefits RB-19a (03-19).pdf 03/15/2019
AA-17rec; Receipt for Claim Form AA-17rec (01-19).pdf 12/21/2018
RL-1S, Transmittal Letter for Self-administered Retirement Applications Form RL-1S (08-18).pdf 03/18/2019
AA-17, Application for Widow(ers) Annuity Form AA-17 (11-18).pdf 12/21/2018
AA-18, Application for Mother's/Father's and Child's Annuity Form AA-18 (11-18).pdf 12/21/2018
AA-19, Application for Child's Annuity Form AA-19 (11-18).pdf 12/21/2018
AA-20, Application for Parent's annuity Form AA-20 (11-18).pdf 12/21/2018
RB-9s, Events that Affect a Survivor Annuity RB-9s (03-09).pdf 03/18/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.