View Information Collection Request (ICR) Package
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View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
3220-0031
ICR Reference No:
201207-3220-002
Status:
Historical Active
Previous ICR Reference No:
200905-3220-003
Agency/Subagency:
RRB
Agency Tracking No:
Title:
Application for Survivor Death Benefits
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
09/13/2012
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/30/2012
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2015
36 Months From Approved
09/30/2012
Responses
10,500
0
11,500
Time Burden (Hours)
2,600
0
2,916
Cost Burden (Dollars)
0
0
0
Abstract:
The collection obtains the information needed to pay death benefits and annuities due but unpaid at death under the Railroad Retirement Act. Benefits are paid to designated beneficiaries or to survivors in a priority designated by law.
Authorizing Statute(s):
US Code:
45 USC 231(f) et seq
Name of Law: Railroad Retirement Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
77 FR 31898
05/30/2012
30-day Notice:
Federal Register Citation:
Citation Date:
77 FR 44698
07/30/2012
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
2
IC Title
Form No.
Form Name
Application for Survivor Death Benefits
G-131 , AA-21 (11-08), AA-21CERT, AA-11a (09-03)
Application for Lump-Sum Death Payments and Annuities Unpaid at Death
,
Authorization of Payment and Release of All Claims to a Death Benefit or Accrued Annuity Payment
,
Designation or Change of Beneficiary for Employees with Service Prior to January 1, 1975, for Residual Lump Sum
,
Application Summary and Certification
Funeral Director's Statement of Burial Charges
G-273a (06-06)
Funeral Director's Statement of Burial Charges
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
10,500
11,500
0
0
-1,000
0
Annual Time Burden (Hours)
2,600
2,916
0
0
-316
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
We have reduced the number of responses for the AA 21cert from 5,400 to 4,500 (-900) and the burden hours from 1,800 to 1,500 (-300). We have also reduced the number of responses for the A-11a from 200 to 100 (-100) and the total burden hours from 33 to 17 (-16). The Residual Lump Sum benefit is being slowly phased out as the population that is eligible to receive a benefit using these forms is diminishing. In addition, we also have more accurate methods of tracking the number of responses to some of our forms. We have reduced the total number of responses from 11,500 to 10,500 (-1,000) and the total burden hours from 2,916 to 2,600 (-316). We have shown the decrease in responses and the corresponding decrease in burden hours as an adjustment.
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
Yes
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Charles Mierzwa 312-751-3363 charles.mierzwa@rrb.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
07/30/2012
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