OMB control number

Application for Survivor Insurance Annuities

OMB 3220-0030 · RRB.

OMB 3220-0030

Under Section 2(d) of the Railroad Retirement Act, monthly survivor annuities are payable to surviving widow(er)s, parents, unmarried children, and in certain cases, divorced wives (husbands), mothers (fathers), remarried widow(er)s and grandchildren of deceased railroad employees. The collection obtains information needed by the RRB to determine entitlement to and the amount of the annuity applied for.

The latest form for Application for Survivor Insurance Annuities expires 2026-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form AA-17b (10-07) Application for Survivor Insurance Annuities Form and Instruction
3220-0030_Final.docx Supporting Statement A
Request OMB Approval of NonSubstantive Change to ICR 3220-0030_Signed.pdf Justification for No Material/Nonsubstantive Change
Application for Survivor Insurance Annuities Form and Instruction

All Historical Document Collections

202411-3220-011	Revision of a currently approved collection	2025-01-21
202404-3220-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-04-03
202206-3220-002 Approved without change	Extension without change of a currently approved collection	2022-06-13
201812-3220-003 Approved without change	Revision of a currently approved collection	2019-03-18
201601-3220-001 Approved without change	Revision of a currently approved collection	2016-02-29
201201-3220-004 Approved without change	Revision of a currently approved collection	2012-11-29
200907-3220-002 Approved without change	Extension without change of a currently approved collection	2009-07-24
200703-3220-004 Approved without change	Revision of a currently approved collection	2007-04-27
200403-3220-001 Approved without change	Extension without change of a currently approved collection	2004-03-04
200102-3220-003 Approved without change	Revision of a currently approved collection	2001-02-23
199808-3220-002 Approved without change	Extension without change of a currently approved collection	1998-08-20
199605-3220-003 Approved without change	Revision of a currently approved collection	1996-05-31
199509-3220-009 Approved without change	No material or nonsubstantive change to a currently approved collection	1995-09-30
199212-3220-002 Approved without change	Revision of a currently approved collection	1992-12-31
199109-3220-004 Approved with change	No material or nonsubstantive change to a currently approved collection	1991-09-23
198910-3220-002 Approved without change	Revision of a currently approved collection	1989-10-17
198904-3220-010 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-07
198709-3220-005 Approved with change	No material or nonsubstantive change to a currently approved collection	1987-09-30
198606-3220-008 Approved without change	Revision of a currently approved collection	1986-06-26
198509-3220-004 Approved with change	No material or nonsubstantive change to a currently approved collection	1985-09-06
198408-3220-002 Approved with change	No material or nonsubstantive change to a currently approved collection	1984-08-22
198305-3220-003 Approved without change	Reinstatement with change of a previously approved collection	1983-05-03
198301-3220-003 Withdrawn and continue	Extension without change of a currently approved collection	1983-01-03
198201-3220-001 Approved without change	Revision of a currently approved collection	1982-01-11
198105-3220-040 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-05-29
197711-3220-003 Approved without change	Revision of a currently approved collection	1977-11-08
197602-3220-001 Approved with change	No material or nonsubstantive change to a currently approved collection	1976-02-19
197601-3220-001 Approved without change	Extension without change of a currently approved collection	1976-01-30