OMB control number

Application for Benefits Due but Unpaid at Death

OMB 3220-0055 · RRB.

OMB 3220-0055

The collection obtains the information needed by the Railroad Retirement Board to pay benefits accrued under section 2(g) of the Railroad Unemployment Insurance Act, but not paid because of the death of the employee.

The latest form for Application for Benefits Due but Unpaid at Death expires 2028-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form Form UI-63 (XX-XX) Application for Benefits Due But Unpaid at Death Form and Instruction
Form UI-63 (01-18) Application for Benefits Due But Unpaid at Death Form and Instruction
Form UI-63 (01-18) Application for Benefits Due but Unpaid at Death Form and Instruction
3220-0055_Final.docx Supporting Statement A
Application for Benefits Due but Unpaid at Death Form and Instruction
Application for Benefits Due but Unpaid at Death Form and Instruction
Application for Benefits Due but Unpaid at Death Form and Instruction

All Historical Document Collections

202504-3220-017	Reinstatement with change of a previously approved collection	2025-06-13
202106-3220-002 Approved without change	Extension without change of a currently approved collection	2021-06-30
201804-3220-001 Approved without change	Revision of a currently approved collection	2018-04-13
201501-3220-001 Approved without change	Extension without change of a currently approved collection	2015-01-30
201112-3220-001 Approved without change	Extension without change of a currently approved collection	2012-01-23
200810-3220-003 Approved without change	Revision of a currently approved collection	2008-12-22
200510-3220-003 Approved without change	Extension without change of a currently approved collection	2005-10-25
200210-3220-003 Approved without change	Extension without change of a currently approved collection	2002-10-10
200001-3220-002 Approved without change	Extension without change of a currently approved collection	2000-01-18
199703-3220-002 Approved without change	Extension without change of a currently approved collection	1997-03-10
199402-3220-001 Approved without change	Revision of a currently approved collection	1994-02-16
199104-3220-003 Approved with change	No material or nonsubstantive change to a currently approved collection	1991-04-09
199011-3220-002 Approved without change	Revision of a currently approved collection	1990-11-29
198708-3220-003 Approved without change	Extension without change of a currently approved collection	1987-08-31
198512-3220-002 Approved with change	No material or nonsubstantive change to a currently approved collection	1985-12-20
198411-3220-002 Approved with change	No material or nonsubstantive change to a currently approved collection	1984-11-13
198409-3220-002 Approved without change	Revision of a currently approved collection	1984-09-26
198109-3220-003 Approved without change	Extension without change of a currently approved collection	1981-09-25
198105-3220-011 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-05-28
198005-3220-007 Approved without change	Extension without change of a currently approved collection	1980-05-01
197904-3220-008 Approved without change	Extension without change of a currently approved collection	1979-04-27
197903-3220-012 Approved without change	Extension without change of a currently approved collection	1979-03-14
197402-3220-002 Approved without change	New collection (Request for a new OMB Control Number)	1974-02-14