Application for Survivor Death Benefits

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.

Latest Forms, Documents, and Supporting Material

Document Name
Form AA-21 (12-18) Application for Survivor Death Benefits Form and Instruction
Form G-273a (06-19) Funeral Director's Statement of Burial Charges Form and Instruction
3220-0031 .docx Supporting Statement A
Form RB-21 (10-18).pdf Supplementary Document
Application for Survivor Death Benefits Form and Instruction
Funeral Director's Statement of Burial Charges Form and Instruction

All Historical Document Collections

202204-3220-002 Approved with change	Revision of a currently approved collection	2022-04-29
201812-3220-001 Approved without change	Revision of a currently approved collection	2019-03-18
201509-3220-004 Approved without change	Revision of a currently approved collection	2015-09-30
201207-3220-002 Approved without change	Extension without change of a currently approved collection	2012-07-30
200905-3220-003 Approved without change	Extension without change of a currently approved collection	2009-05-26
200603-3220-003 Approved without change	Extension without change of a currently approved collection	2006-03-28
200302-3220-001 Approved without change	Extension without change of a currently approved collection	2003-02-10
199912-3220-001 Approved without change	Revision of a currently approved collection	1999-12-02
199609-3220-002 Approved without change	Revision of a currently approved collection	1996-09-26
199308-3220-001 Approved without change	Extension without change of a currently approved collection	1993-08-19
199006-3220-001 Approved without change	Extension without change of a currently approved collection	1990-06-01
198703-3220-001 Approved without change	Revision of a currently approved collection	1987-03-09
198609-3220-002 Approved with change	No material or nonsubstantive change to a currently approved collection	1986-09-30
198606-3220-002 Approved without change	Revision of a currently approved collection	1986-06-04
198509-3220-005 Approved with change	No material or nonsubstantive change to a currently approved collection	1985-09-06
198304-3220-004 Approved without change	Revision of a currently approved collection	1983-04-11
198301-3220-001 Withdrawn and continue	Extension without change of a currently approved collection	1983-01-03
198111-3220-004 Approved without change	Revision of a currently approved collection	1981-11-17
198106-3220-010 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-06-30
198105-3220-046 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-05-29
198101-3220-006 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-01-13
198012-3220-022 Approved with change	No material or nonsubstantive change to a currently approved collection	1980-12-30
198011-3220-001 Approved without change	Extension without change of a currently approved collection	1980-11-26
198010-3220-004 Approved with change	No material or nonsubstantive change to a currently approved collection	1980-10-28
198005-3220-009 Approved without change	Extension without change of a currently approved collection	1980-05-28
197904-3220-010 Approved without change	Extension without change of a currently approved collection	1979-04-27
197903-3220-015 Approved without change	Extension without change of a currently approved collection	1979-03-14
197803-3220-016 Approved without change	Extension without change of a currently approved collection	1978-03-31
197803-3220-015 Approved without change	Extension without change of a currently approved collection	1978-03-06
197512-3220-011 Approved with change	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 Death	Paper Only	Form and instruction
Form G-131 (12-18)	Authorization of Payment and Release of All Claims to a Death Benefit or Accrued Annuity Payment	Paper Only	Form and instruction
Form AA-21 (12-18)	Application for Lump-Sum Death Payments and Annuities Unpaid at Death	Paper Only	Form and instruction
Form AA-21CERT (All Possible)	Application Summary and Certification	Paper Only	Form
Form G-273A (04-16)	Funeral Director's Statement of Burial Expenses	Paper Only	Form
Form AA-21CERT All Possible (Proposed)	Application Summary and Certification	Paper Only	Form
Form AA-21CERT Completed	Application Summary and Certification	Paper Only	Form
Form AA-21CERT Completed (Proposed)	Application Summary and Certification	Paper Only	Form
Form G-273A (Proposed)	Funeral Director's Statement of Burial Expenses	Paper Only	Form

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