Information Collection

Employee's Certification

IC 33938 under ICR 202506-3220-001 · OMB 3220-0140.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-346 (03-18) Employee's Certification	Form
Form G-346 (03-18) Employee's Certification Employee's Certification	Form
Form G-346sum (03-18) Employee's Certification Summary Employee's Certification	Form
Form G-346sum (03-18) Employee's Certification Summary Employee's Certification	Form
Form Form G-346 (XX-XX) Employee's Certification Employee's Certification	Form and Instruction
G-346 (03-18) Employee's Certification Form G-346 (03-18).pdf	Form
G-346 (03-18) Employee's Certification Form G-346 (03-18).pdf	Form
G-346sum (03-18) Employee's Certification Summary Form G-346sum All (03-18).pdf	Form
G-346sum (03-18) Employee's Certification Summary Form G-346sum All (03-18).pdf	Form
G-346sum (03-18) Employee's Certification Summary Form G-346sum Completed (03-18).pdf	Form
G-346sum (03-18) Employee's Certification Summary Form G-346sum Completed (03-18).pdf	Form
Form G-346 (XX-XX) Employee's Certification Form G-346 (XX-XX) Proposed.docx	Form and Instruction
Form G-346 (XX-XX) Employee's Certification Form G-346 (XX-XX) Proposed.docx	Form and Instruction
Form AA-7 (01-18).pdf AA-7, Spouse/Divorced Spouse Application for Medicare	IC Document
Form AA-7 (01-18).pdf AA-7, Spouse/Divorced Spouse Application for Medicare	IC Document
Form AA-3 (07-17).pdf AA-3, Application for Spouse/Divorced Spouse Annuity	IC Document
Form AA-3 (07-17).pdf AA-3, Application for Spouse/Divorced Spouse Annuity	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 217(17)(f)(3) 20 CFR 219.30 - 219.35 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	G-346 (03-18)	No		Paper Only
Form	G-346sum (03-18)	Yes	No	Printable Only
Form	G-346sum (03-18)	Yes	No	Printable Only
Form and Instruction	Form G-346 (XX-XX) Proposed	No		Paper Only

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records

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

FR Citation: 79 FR 58874

Number of Respondents: 4,020

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 49 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	4,020	-1,540	5,560
Annual IC Time Burden (Hours)	335	-153	488
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
AA-7, Spouse/Divorced Spouse Application for Medicare		11/30/2021
AA-3, Application for Spouse/Divorced Spouse Annuity		10/03/2018

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].