Application for Survivor Insurance Annuities

Forms and Documents

Document Name	Status
Form AA-19 (proposed) Application for Survivor Insurance Annuities Form and Instruction	Modified
3220-0030.doc Supporting Statement A	2012-11-29

IC Document Collections

IC ID	Document Title	Status
33834	Application for Survivor Insurance Annuities Form and Instruction	Modified

ICR Details

OMB Control No: 3220-0030	ICR Reference No: 201201-3220-004
Status: Historical Active	Previous ICR Reference No: 200907-3220-002
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 without change	Conclusion Date: 02/14/2013
	Date Received in OIRA: 11/29/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2016	36 Months From Approved	02/28/2013
Responses	3,722	0	3,722
Time Burden (Hours)	1,494	0	1,529
Cost Burden (Dollars)	0	0	0

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Abstract: Under Section 2(d) of the Railroad Retirement Act, monthly survivor annuities are payable to surviving widow(er)s, parents, unmarried children, and in certain cases, divorced wives (husbands), mothers (fathers), remarried widow(er)s and grandchildren of deceased railroad employees. The collection obtains information needed by the RRB for determining entitlement to and amount of the annuity applied for.

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Authorizing Statute(s): US Code: 45 USC 231f Name of Law: Railroad Retirement Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 1093	01/09/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 68878	11/07/2012
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Application for Survivor Insurance Annuities	AA-20 (08-09), AA-17cert (09-06)(all possible), AA-19 (08-09), AA-18 (08-09), AA-17 (08-09), AA-17b (10-07), AA-19a (10-07), AA-17cert (09-06), AA-17cert (proposed)(All Possible) , AA-17sum proposed (completed) , AA-17 (Proposed) , AA-18 (proposed) , AA-19 (proposed) , AA-20 (proposed) , AA-17cert proposed (Completed) , AA-17sum proposed (all possible)	Application for Child's Annuity ,   Application for Parent's Annuity ,   Application Summary and Certification ,   Application Summary and Certification ,   Application Summary ,   Application Summary ,   Application for Child's Annuity ,   Application for Determination of Child's Disability ,   Applicationfor Parent's Annuity ,   Application Summary and Certification ,   Application Summary and Certification ,   Application for Widow(ers) Annuity ,   Application for Mother/Father's and Childs Annuity ,   Applications for Mother's/Father's and Child's Annuity ,   Application for Widow(ers) Annuity ,   Application for Determination of Widow(ers) Disability

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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	3,722	3,722	0	0	0	0
Annual Time Burden (Hours)	1,494	1,529	0	-35	0	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: Implementing "Attestation" requires the creation of new Form AA-17sum. We anticipate 2,100 of the 3,722 applicants currently using the AA-17cert, will use "Attestation," resulting in a decrease in the number of Forms AA-17cert used to 900. We also propose that using "Attestation" will take one minute less to complete, decreasing the burden by 35 hours, from 1,529 to 1,494. We have shown the decrease in burden hours as a program change.

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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

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Common Form ICR:  No

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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: 11/29/2012

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