Information Collection

Statement of Claimant or Other Person

IC 44220 under ICR 202504-3220-021 · OMB 3220-0183.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-93 (09-18) Statement of Claimant or Other Person	Form
Form G-93 (09-18) Statement of Claimant or Other Person Statement of Claimant or Other Person	Form
G-93 (09-18) Statement of Claimant or Other Person Form G-93 (09-18).pdf	Form
G-93 (09-18) Statement of Claimant or Other Person Form G-93 (09-18).pdf	Form
SSA-795 (06-2022).pdf Statement of Claimant or Other Person	IC Document
SSA-795 (06-2022).pdf Statement of Claimant or Other Person	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 320 20 CFR 217

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	G-93 (09-18)				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 System

FR Citation: 79 FR 58874

Number of Respondents: 400

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	400	-900	1,300
Annual IC Time Burden (Hours)	100	-225	325
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Statement of Claimant or Other Person		06/18/2025

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

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