Information Collection

Evidence of Marital Relationship - Living with Requirements

IC 33823 under ICR 202507-3220-001 · OMB 3220-0021.

Documents and Forms

Document Name Document Type
Form G-124 (03-23) Statement of Marital Relationship Evidence of Marital Relationship - Living with Requirements Form
Form G-124A (03-23) Statement Regarding Marriage Evidence of Marital Relationship - Living with Requirements Form
Form G-237 (03-203 Statement Regarding Marital Status Evidence of Marital Relationship - Living with Requirements Form and Instruction
Form G-238A (07-20) Statement Regarding Divorce or Annulment Evidence of Marital Relationship - Living with Requirements Form
Form G-238 (07-20) Statement of Residence Evidence of Marital Relationship - Living with Requirements Form
G-124 (03-23) Statement of Marital Relationship G-124 (03-23).pdf Form
G-124A (03-23) Statement Regarding Marriage G-124A (03-23).pdf Form
G-237 (03-203 Statement Regarding Marital Status G-237 (03-23).pdf Form and Instruction
G-238A (07-20) Statement Regarding Divorce or Annulment Form G-238A (07-20).pdf Form
G-238 (07-20) Statement of Residence Form G-238 (07-20).pdf Form
Form G-242 (01-07).pdf Notice of Information Needed in Claim under Railroad Retirement Act IC Document
Form RL-26F (05-08).pdf RL-26, Transmittal Letter, Instruction Sheet IC Document
Form RL-57A-F (10-82).pdf RL-57A-F, Transmittal letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evidence of Marital Relationship - Living with Requirements	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 219.3

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	G-124 (03-23)	Statement of Marital Relationship	G-124 (03-23).pdf	No	Paper Only
Form	G-124A (03-23)	Statement Regarding Marriage	G-124A (03-23).pdf	No	Paper Only
Form and Instruction	G-237 (03-203	Statement Regarding Marital Status	G-237 (03-23).pdf	No	Paper Only
Form	G-238A (07-20)	Statement Regarding Divorce or Annulment	Form G-238A (07-20).pdf	No	Paper Only
Form	G-238 (07-20)	Statement of Residence	Form G-238 (07-20).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 System	FR Citation: 79 FR 58874

Number of Respondents: 1,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,100	1,100
Annual IC Time Burden (Hours)	196	196
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Notice of Information Needed in Claim under Railroad Retirement Act	Form G-242 (01-07).pdf	01/24/2012
RL-26, Transmittal Letter, Instruction Sheet	Form RL-26F (05-08).pdf	01/24/2012
RL-57A-F, Transmittal letter	Form RL-57A-F (10-82).pdf	01/24/2012

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

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