View Information Collection Request (ICR) Package

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: 3220-0030	ICR Reference No: 202411-3220-011
Status: Active	Previous ICR Reference No: 202404-3220-001
Agency/Subagency: RRB	Agency Tracking No:
Title: Application for Survivor Insurance Annuities
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/03/2026
	Date Received in OIRA: 01/21/2025
Terms of Clearance: Approved consistent with E.O. 14168.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2029	36 Months From Approved	09/30/2026
Responses	3,410	0	3,485
Time Burden (Hours)	1,314	0	1,337
Cost Burden (Dollars)	0	0	0

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for Survivor Insurance Annuities	AA-19a (XX-XX) - Proposed, AA-17b (XX-XX) - Proposed, AA-17cert (09-15)(all possible), AA-17b (10-07), AA-19a (10-07), AA-17cert (09-15), AA-17sum (01-19) (Completed), AA-17sum (01-19) (All possible)	, , , , , , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	3,410	3,485	-75
Annual Time Burden (Hours)	1,314	1,337	-23
Annual Cost Burden (Dollars)	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: While conducting a review, the annual responses decreased from 3,485 to 3,410 and the burden decreased from 1,337 to 1,314 due to the enhancements the RRB made in how it electronically tracks and stores completed forms, to provide more accurate burden estimate.

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. 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? No

Agency Contact: Brian Foster 312 751-4826 brian.foster@rrb.gov

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.