Repayment of Debt

OMB 3220-0169

When the RRB determines that an overpayment of benefits under the Railroad Retirement Act or Railroad Unemployment Insurance Act has occurred, it initiates prompt action to notify the claimant of the overpayment and to recover the amount owed. The collection obtains information needed to allow for repayment by the claimant by credit card, in addition to the customary form of payment by check or money order.

The latest form for Repayment of Debt expires 2023-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form G-421F (04-20) Repayment by Credit Card Form
Form G-421F (04-20) Repayment by Credit Card Form
3220-0169 .docx Supporting Statement A
Form DRL-145 (12-17).pdf Supplementary Document
Form DR-422B (02-18).pdf Supplementary Document
Form DR-422A (02-18).pdf Supplementary Document
Form DRL-145 (07-16).pdf Supplementary Document
Form SSA-714 (07-05).pdf Supplementary Document
Form G-66BA (03-13).pdf Supplementary Document
DR-422C (09-19).pdf Supplementary Document
Form G-421 (02-18).pdf Supplementary Document
G-66B (02-03).pdf Supplementary Document
G-66 (02-03).pdf Supplementary Document
Form G-66A (03-13).pdf Supplementary Document
Repayment by Credit Card Form
Repayment by Credit Card Form

All Historical Document Collections

202303-3220-005 Approved without change	Extension without change of a currently approved collection	2023-03-28
201912-3220-005 Approved with change	Revision of a currently approved collection	2019-12-30
201712-3220-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2017-12-28
201606-3220-002 Approved without change	Extension without change of a currently approved collection	2016-08-22
201304-3220-001 Approved without change	Revision of a currently approved collection	2013-04-26
200912-3220-001 Approved without change	Revision of a currently approved collection	2009-12-28
200609-3220-001 Approved without change	Extension without change of a currently approved collection	2006-09-29
200307-3220-001 Approved without change	Extension without change of a currently approved collection	2003-07-15
200005-3220-001 Approved without change	Extension without change of a currently approved collection	2000-05-02
199701-3220-001 Approved without change	Extension without change of a currently approved collection	1997-01-14
199601-3220-001 Approved without change	Extension without change of a currently approved collection	1996-01-26
199509-3220-002 Approved without change	No material or nonsubstantive change to a currently approved collection	1995-09-30
199209-3220-002 Approved without change	Revision of a currently approved collection	1992-09-01
198905-3220-004 Approved without change	New collection (Request for a new OMB Control Number)	1989-05-09

OMB Details

Repayment by Credit Card

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form G-421F (12-17)	Repayment by Debit Card - (Current)	Paper Only	Form
Form G-421F (XX-XX)	Repayment by Debit Card - (proposed)	Paper Only	Form

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