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

View Information Collection (IC)

Application for Survivor Death Benefits
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 234 20 CFR 217 20 CFR 219

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction G-131 (12-18) No   Paper Only
Form AA-21CERT (All Possible) No   Paper Only
Form and Instruction AA-21 (08-25) No   Paper Only
Form AA-21CERT Completed No   Paper Only

Income Security Survivor Compensation

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

3,720 0
   
Individuals or Households
 
   92 %

  Requested 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 3,720 0 0 -80 3,800 0
Annual IC Time Burden (Hours) 1,302 0 0 -6 1,308 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
AA-11a, Designation or Change of Beneficiary for Employees with Service Prior to January 1, 1975, for Residual Lump Sum 03/18/2019
RB-21, Lump-Sum Death Payment, Residual Lump-Sum, Annuities Unpaid at Death 03/18/2019
AA-21 - Application for Survivor Benefits - Receipt for Claim 04/22/2022
AA-21 - Application for Survivor Benefits - Receipt for Claim 04/29/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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