Repayment of Debt

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form G-421F (XX-XX) Repayment by Debit Card	Form	Modified	Repair queued
Form G-421F (04-20) Repayment by Credit Card - Current	Form	Modified	Missing upstream
Form G-421F (04-20) Repayment by Credit Card - Current	Form	Unchanged	Available
Form G-421F (XX-XX) Repayment by Debit Card	Form	Modified	Repair queued
Form G-421F (04-20) Repayment by Debit Card - (Current)	Form	Modified	Missing upstream
Form G-421F (04-20) Repayment by Debit Card - (Current)	Form	Unchanged	Available
3220-0169_Final_OMB Passback Update.docx	Supporting Statement A	Uploaded 2026-10-21	Repair queued
3220-0169_Final.docx	Supporting Statement A	Uploaded 2026-05-28	Available
Form DRL-145 (12-17).pdf	Supplementary Document	Uploaded 2017-12-28	Repair queued
Form DRL-145 (12-17).pdf	Supplementary Document	Uploaded 2017-12-28	Available
Form DR-422B (02-18).pdf	Supplementary Document	Uploaded 2023-03-21	Repair queued
Form DR-422B (02-18).pdf	Supplementary Document	Uploaded 2023-03-21	Available
Form DR-422A (02-18).pdf	Supplementary Document	Uploaded 2023-03-21	Repair queued
Form DR-422A (02-18).pdf	Supplementary Document	Uploaded 2023-03-21	Available
Form DRL-145 (07-16).pdf	Supplementary Document	Uploaded 2016-08-04	Repair queued
Form DRL-145 (07-16).pdf	Supplementary Document	Uploaded 2016-08-04	Available
Form SSA-714 (03-26).pdf	Supplementary Document	Uploaded 2026-09-04	Repair queued
Form SSA-714 (07-05).pdf	Supplementary Document	Uploaded 2016-06-08	Available
Form G-66BA (03-13).pdf	Supplementary Document	Uploaded 2016-06-08	Repair queued
Form G-66BA (03-13).pdf	Supplementary Document	Uploaded 2016-06-08	Available
DR-422C (09-19).pdf	Supplementary Document	Uploaded 2023-03-21	Repair queued
DR-422C (09-19).pdf	Supplementary Document	Uploaded 2023-03-21	Available
Form G-421 (02-18).pdf	Supplementary Document	Uploaded 2023-03-21	Repair queued
Form G-421 (02-18).pdf	Supplementary Document	Uploaded 2023-03-21	Available
G-66B (02-03).pdf	Supplementary Document	Uploaded 2006-09-29	Repair queued
G-66B (02-03).pdf	Supplementary Document	Uploaded 2006-09-29	Available
G-66 (02-03).pdf	Supplementary Document	Uploaded 2006-09-29	Repair queued
G-66 (02-03).pdf	Supplementary Document	Uploaded 2006-09-29	Available
Form G-66A (03-13).pdf	Supplementary Document	Uploaded 2016-06-08	Repair queued
Form G-66A (03-13).pdf	Supplementary Document	Uploaded 2016-06-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45464	Repayment by Credit Card	Form	Modified	Repayment by Debit Card
45464	Repayment by Credit Card	Form	Modified	Repayment by Credit Card - Current
45464	Repayment by Credit Card	Form	Unchanged	Repayment by Credit Card - Current
33968	Repayment by Credit Card	Form	Modified	Repayment by Debit Card
33968	Repayment by Credit Card	Form	Modified	Repayment by Debit Card - (Current)
33968	Repayment by Credit Card	Form	Unchanged	Repayment by Debit Card - (Current)

ICR Details

OMB Control No: 3220-0169	ICR Reference No: 202507-3220-007
Status: Active	Previous ICR Reference No: 202303-3220-005
Agency/Subagency: RRB	Agency Tracking No:
Title: Repayment of Debt
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/26/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/01/2026
Terms of Clearance: To the extent it can, the agency will update this information collection to ensure compliance with EO 14247 no later than calendar year 2027.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2029	36 Months From Approved	10/31/2026
Responses	535	0	535
Time Burden (Hours)	45	0	45
Cost Burden (Dollars)	0	0	0

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Abstract: When the RRB determines that an overpayment of benefits under the Railroad Retirement Act or Railroad Unemployment Insurance Act has occurred, it initiates prompt action to notify the claimant of the overpayment and to recover the amount owed. The collection obtains information needed to allow for repayment by the claimant by credit card, in addition to the customary form of payment by check or money order.

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Authorizing Statute(s): US Code: 45 USC 362(l) Name of Law: Railroad Unemployment Insurance Act
   US Code: 45 USC 231(i) Name of Law: Railroad Retirement Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 13869	03/23/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 30749	05/26/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Repayment by Credit Card	G-421F (04-20), G-421F (XX-XX)	Repayment by Credit Card - Current ,   Repayment by Debit Card
Repayment by Credit Card	G-421F (04-20), G-421F (XX-XX)	Repayment by Debit Card - (Current) ,   Repayment by Debit Card

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	535	535	0	0	0	0
Annual Time Burden (Hours)	45	45	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/01/2026

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