View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Application for Survivor Insurance Annuities
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 219 20 CFR 217 20 CFR 218 20 CFR 216

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction AA-17b (10-07) Application for Determination of Widow(ers) Disability Form AA-17b (10-07).pdf No   Paper Only
Form and Instruction AA-19a (10-07) Application for Determination of Child's Disability Form AA-19a (10-07).pdf No   Paper Only
Form AA-17cert (09-15)(all possible) Application Summary and Certification Form AA-17cert (09-15) (All Possible).pdf Yes Yes Printable Only
Form AA-17cert (09-15) Application Summary and Certification Form AA-17cert (09-15) (Completed).pdf Yes Yes Printable Only
Form AA-17sum (09-15) (All possible) Application Summary Form AA-17sum (09-15) (All Possible).pdf Yes Yes Printable Only
Form AA-17sum (09-15) (Completed) Application Summary Form AA-17sum (09-15) (Completed).pdf Yes Yes Printable Only

Income Security General Retirement and Disability

RRB-22, Railroad Retirement, Survivor, and Pensioner Benefit System   79 FR 58874

3,485 0
   
Individuals or Households
 
   86 %

  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 3,485 0 0 -237 0 3,722
Annual IC Time Burden (Hours) 1,315 0 0 -179 0 1,494
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
RB-3 Booklet; Furnishing Evidence to Support Your Claim RB-3 (11-08).pdf 07/16/2009
RB-17 Booklet, Survivor Annuities Form RB-17 (09-15).pdf 02/09/2016
RB-17b Booklet; Widow(ers) Disability Benefits RB-17b (03-09).pdf 07/16/2009
RB-19A Booklet; Child's Disability Benefits RB-19a (5-99).pdf 05/03/1999
AA-17rec; Receipt for Claim Form AA-17rec (11-14).pdf 01/06/2016
Transmittal Letter for self-administered retirement applications Form RL-1S (04-07).pdf 11/29/2012
AA-17, Application for Widow(ers) Annuity Form AA-17 (07-15).pdf 02/26/2016
AA-18, Application for Mother's/Father's and Child's Annuity Form AA-18 (07-15).pdf 02/26/2016
AA-19, Application for Child's Annuity Form AA-19 (07-15).pdf 02/26/2016
AA-20, Application for Parent's annuity Form AA-20 (07-15).pdf 02/26/2016
AA-17, Proposed (less than 10 responses) Form AA-17 proposed.pdf 02/26/2016
AA-18 proposed (less than 10 responses) Form AA-18 proposed.pdf 02/26/2016
AA-19 proposed (less than 10 responses) Form AA-19 proposed.pdf 02/26/2016
AA-20 proposed (less than 10 responses) Form AA-20 proposed.pdf 02/26/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.