Statement Regarding Contributions and Support

OMB 3220-0099

Dependency on the employee for one-half support at the time of the employee's death can be a condition affecting eligibility for a survivor annuity provided for under Section 2 of the Railroad Retirement Act. One-half support is also a condition which may negate the public service pension offset in Tier I for a spouse or widow(er).

The latest form for Statement Regarding Contributions and Support expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form G-134 (Proposed) Statement Regarding Contributions and Support Form
3220-0099.docx Supporting Statement A
Statement Regarding Contributions and Support Form

All Historical Document Collections

202011-3220-003	Revision of a currently approved collection	2020-11-24
201709-3220-005 Approved without change	Extension without change of a currently approved collection	2017-09-20
201407-3220-006 Approved without change	Extension without change of a currently approved collection	2014-08-05
201107-3220-003 Approved without change	Extension without change of a currently approved collection	2011-07-21
200803-3220-002 Approved without change	Extension without change of a currently approved collection	2008-05-23
200505-3220-002 Approved without change	Extension without change of a currently approved collection	2005-05-26
200204-3220-002 Approved without change	Extension without change of a currently approved collection	2002-04-26
199904-3220-002 Approved without change	Revision of a currently approved collection	1999-04-19
199902-3220-001 Approved without change	No material or nonsubstantive change to a currently approved collection	1999-02-23
199512-3220-001 Approved without change	Extension without change of a currently approved collection	1995-12-29
199509-3220-001 Approved without change	No material or nonsubstantive change to a currently approved collection	1995-09-30
199209-3220-003 Approved without change	Extension without change of a currently approved collection	1992-09-24
198907-3220-005 Approved without change	Extension without change of a currently approved collection	1989-07-31
198904-3220-011 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-07
198904-3220-006 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-04
198607-3220-003 Approved without change	Extension without change of a currently approved collection	1986-07-23
198308-3220-004 Approved without change	Revision of a currently approved collection	1983-08-17
198105-3220-023 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-05-28
198005-3220-005 Approved without change	Revision of a currently approved collection	1980-05-28
197904-3220-006 Approved without change	Extension without change of a currently approved collection	1979-04-27
197903-3220-008 Approved without change	Extension without change of a currently approved collection	1979-03-14
197803-3220-014 Approved without change	Extension without change of a currently approved collection	1978-03-31
197803-3220-013 Approved without change	Extension without change of a currently approved collection	1978-03-06