OMB control number

Application for Survivor Death Benefits

OMB 3220-0031 · RRB.

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 2029-05-31 and is listed under ICR 202509-3220-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form AA-21CERT Complete Application Summary and Certification	Form
Form AA-21 (08-25) Application for Lump-Sum Death Payment and Annuities Unpaid at Death	Form and Instruction
Form AA-21CERT (All Pos Application Summary and Certification	Form
Form AA-21CERT (All Pos Application Summary and Certification	Form
Form G-131 (12-18) Authorization of Payment and Release of All Claims to a Death Benefit or Accrued Annuity Payment	Form and Instruction
Form G-131 (12-18) Authorization of Payment and Release of All Claims to a Death Benefit or Accrued Annuity Payment	Form and Instruction
Form G-273A (08-25) Funeral Director's Statement of Burial Expenses	Form and Instruction
Form G-273A (08-25) Funeral Director's Statement of Burial Expenses	Form and Instruction
Form G-273A (Proposed) Funeral Director's Statement of Burial Expenses	Form and Instruction
Form G-273A (Proposed) Funeral Director's Statement of Burial Expenses	Form and Instruction
3220-0031_Final.docx	Supporting Statement A
3220-0031_Final.docx	Supporting Statement A
Form G-273A (xx-xx) - Proposed 08082025.pdf	Justification for No Material/Nonsubstantive Change
Form G-273A (xx-xx) - Proposed 08082025.pdf	Justification for No Material/Nonsubstantive Change
Form AA-21 (xx-xx) - Proposed 08082025.pdf	Justification for No Material/Nonsubstantive Change
Form AA-21 (xx-xx) - Proposed 08082025.pdf	Justification for No Material/Nonsubstantive Change
Request OMB Approval of NonSubstantive Change to ICR 3220-0031_Signed.pdf	Justification for No Material/Nonsubstantive Change
Request OMB Approval of NonSubstantive Change to ICR 3220-0031_Signed.pdf	Justification for No Material/Nonsubstantive Change
Application for Survivor Death Benefits	Form
Application for Survivor Death Benefits	Form
Application for Survivor Death Benefits	Form and Instruction
Application for Survivor Death Benefits	Form and Instruction
Application for Survivor Death Benefits	Form
Application for Survivor Death Benefits	Form
Application for Survivor Death Benefits	Form and Instruction
Application for Survivor Death Benefits	Form and Instruction
Funeral Director's Statement of Burial Charges	Form and Instruction
Funeral Director's Statement of Burial Charges	Form and Instruction
Funeral Director's Statement of Burial Charges	Form and Instruction
Funeral Director's Statement of Burial Charges	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202509-3220-001	Reinstatement with change of a previously approved collection	2025-12-31
202508-3220-001	No material or nonsubstantive change to a currently approved collection	2025-08-08	Approved without change
202204-3220-002	Revision of a currently approved collection	2022-04-29	Approved with change
201812-3220-001	Revision of a currently approved collection	2019-03-18	Approved without change
201509-3220-004	Revision of a currently approved collection	2015-09-30	Approved without change
201207-3220-002	Extension without change of a currently approved collection	2012-07-30	Approved without change
200905-3220-003	Extension without change of a currently approved collection	2009-05-26	Approved without change
200603-3220-003	Extension without change of a currently approved collection	2006-03-28	Approved without change
200302-3220-001	Extension without change of a currently approved collection	2003-02-10	Approved without change
199912-3220-001	Revision of a currently approved collection	1999-12-02	Approved without change
199609-3220-002	Revision of a currently approved collection	1996-09-26	Approved without change
199308-3220-001	Extension without change of a currently approved collection	1993-08-19	Approved without change
199006-3220-001	Extension without change of a currently approved collection	1990-06-01	Approved without change
198703-3220-001	Revision of a currently approved collection	1987-03-09	Approved without change
198609-3220-002	No material or nonsubstantive change to a currently approved collection	1986-09-30	Approved with change
198606-3220-002	Revision of a currently approved collection	1986-06-04	Approved without change
198509-3220-005	No material or nonsubstantive change to a currently approved collection	1985-09-06	Approved with change
198304-3220-004	Revision of a currently approved collection	1983-04-11	Approved without change
198301-3220-001	Extension without change of a currently approved collection	1983-01-03	Withdrawn and continue
198111-3220-004	Revision of a currently approved collection	1981-11-17	Approved without change
198106-3220-010	No material or nonsubstantive change to a currently approved collection	1981-06-30	Approved with change
198105-3220-046	No material or nonsubstantive change to a currently approved collection	1981-05-29	Approved with change
198101-3220-006	No material or nonsubstantive change to a currently approved collection	1981-01-13	Approved with change
198012-3220-022	No material or nonsubstantive change to a currently approved collection	1980-12-30	Approved with change
198011-3220-001	Extension without change of a currently approved collection	1980-11-26	Approved without change
198010-3220-004	No material or nonsubstantive change to a currently approved collection	1980-10-28	Approved with change
198005-3220-009	Extension without change of a currently approved collection	1980-05-28	Approved without change
197904-3220-010	Extension without change of a currently approved collection	1979-04-27	Approved without change
197903-3220-015	Extension without change of a currently approved collection	1979-03-14	Approved without change
197803-3220-016	Extension without change of a currently approved collection	1978-03-31	Approved without change
197803-3220-015	Extension without change of a currently approved collection	1978-03-06	Approved without change
197512-3220-011	No material or nonsubstantive change to a currently approved collection	1975-12-22	Approved with change

OMB Details

Application for Survivor Death Benefits

Federal Enterprise Architecture: Income Security - Survivor Compensation

Information collection instruments
Form	Name	Electronic access	Type
Form AA-21CERT (All Possible)	Application Summary and Certification	Paper Only	Form
Form AA-21CERT Completed	Application Summary and Certification	Paper Only	Form
Form AA-21 (08-25)	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

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