View Information Collection (IC)

View Information Collection (IC)

IC Title:	Application for Spouse Annuity Under the Railroad Retirement Act	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 216.50 20 CFR 218.11

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	AA-3cert (all possible)	Application Summary and Certification	Form AA-3cert (04-13) All possible.pdf		Yes	Yes	Fillable Printable
Form	AA-3cert (completed)	Application Summary and Certification	Form AA-3cert (04-13) Completed.pdf		Yes	Yes	Fillable Printable
Form	AA-3sum (all possible)	Application Summary	Form AA-3sum (11-14) All Possible.pdf		Yes	Yes	Fillable Printable
Form	AA-3sum (completed)	Application Summary	Form AA-3sum (11-14) Completed.pdf		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records
Title: RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System	FR Citation: 79 FR 58874

Number of Respondents: 11,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	11,700	0	0	650	0	11,050
Annual IC Time Burden (Hours)	5,733	0	0	409	0	5,324
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
RL-1	Form RL-1 (04-07).pdf	02/25/2010
RB-3, Furnishing Evidence To Support Your Claim	Form RB-3 (11-08).pdf	02/25/2010
RB-30, Spouse/Divorced Spouse Annuity	Form RB-30 (01-16).pdf	02/19/2016
RB-9, Employee and Spouse Annuities - Events That Must Be Reported	Form RB-09 (03-09).pdf	02/25/2010
AA-7, Spouse/Divorced Application for Medicare	Form AA-7 (01-12).pdf	12/05/2012
G-208, Public Service Pension Questionnaire	Form G-208 (01-14).pdf	02/19/2016
G-19F, Earnings Information Request	Form G-19F (02-16).pdf	02/19/2016
AA-3 (07-15) Application for Spouse/Divorced Spouse Annuity	Form AA-3 (07-15).pdf	02/26/2016
AA-3 (proposed) < than 10 responses	Form AA-3 proposed less than 10.pdf	02/26/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.