Application for Survivor Death Benefits

OMB 3220-0031

OMB 3220-0031

The collection obtains the information needed to pay death benefits and annuities due but unpaid at death under the Railroad Retirement Act. Benefits are paid to designated beneficiaries or to survivors in a priority designated by law.

The latest form for Application for Survivor Death Benefits expires 2022-05-31 and can be found here.

All Historical Document Collections
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Revision of a currently approved collection 2022-04-29
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Revision of a currently approved collection 2019-03-18
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Revision of a currently approved collection 2015-09-30
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Extension without change of a currently approved collection 2012-07-30
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Extension without change of a currently approved collection 2009-05-26
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Revision of a currently approved collection 1999-12-02
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Revision of a currently approved collection 1996-09-26
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Extension without change of a currently approved collection 1993-08-19
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Extension without change of a currently approved collection 1990-06-01
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Revision of a currently approved collection 1987-03-09
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No material or nonsubstantive change to a currently approved collection 1986-09-30
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Revision of a currently approved collection 1986-06-04
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No material or nonsubstantive change to a currently approved collection 1985-09-06
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Revision of a currently approved collection 1983-04-11
Withdrawn and continue
Extension without change of a currently approved collection 1983-01-03
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Revision of a currently approved collection 1981-11-17
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No material or nonsubstantive change to a currently approved collection 1981-06-30
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No material or nonsubstantive change to a currently approved collection 1981-05-29
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No material or nonsubstantive change to a currently approved collection 1981-01-13
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No material or nonsubstantive change to a currently approved collection 1980-12-30
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Extension without change of a currently approved collection 1980-11-26
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No material or nonsubstantive change to a currently approved collection 1980-10-28
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Extension without change of a currently approved collection 1980-05-28
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Extension without change of a currently approved collection 1979-04-27
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Extension without change of a currently approved collection 1979-03-14
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Extension without change of a currently approved collection 1978-03-31
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Extension without change of a currently approved collection 1978-03-06
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No material or nonsubstantive change to a currently approved collection 1975-12-22
OMB Details

Application for Survivor Death Benefits

Federal Enterprise Architecture: Income Security - Survivor Compensation

Form AA-21 (Proposed)Application for Lump-Sum Death Payment and Annuities Unpaid at DeathPaper OnlyForm and instruction
Form G-131 (12-18)Authorization of Payment and Release of All Claims to a Death Benefit or Accrued Annuity Payment Paper OnlyForm and instruction
Form AA-21 (12-18)Application for Lump-Sum Death Payments and Annuities Unpaid at Death Paper OnlyForm and instruction
Form AA-21CERT (All Possible)Application Summary and Certification Paper OnlyForm
Form G-273A (04-16)Funeral Director's Statement of Burial ExpensesPaper OnlyForm
Form AA-21CERT All Possible (Proposed)Application Summary and Certification Paper OnlyForm
Form AA-21CERT CompletedApplication Summary and Certification Paper OnlyForm
Form AA-21CERT Completed (Proposed)Application Summary and CertificationPaper OnlyForm
Form G-273A (Proposed)Funeral Director's Statement of Burial ExpensesPaper OnlyForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.


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