Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment

Forms and Documents

Document Name	Status
Form G-19L Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment Form	Modified
3220-0179.doc Supporting Statement A	2015-04-10
Form G-77a (11-14).pdf Supplementary Document	2015-02-27

IC Document Collections

IC ID	Document Title	Status
33989	Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment Form	Modified

ICR Details

OMB Control No: 3220-0179	ICR Reference No: 201502-3220-003
Status: Historical Active	Previous ICR Reference No: 201201-3220-006
Agency/Subagency: RRB	Agency Tracking No:
Title: Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment
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: 05/15/2015
	Date Received in OIRA: 04/10/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved	05/31/2015
Responses	300	0	300
Time Burden (Hours)	75	0	75
Cost Burden (Dollars)	0	0	0

---

Abstract: Under Section 2(e)(3) of the Railroad Retirement Act, an annuity is not payable or is reduced for any month in which the beneficiary works for a railroad or earns more than the prescribed amounts. The collection obtains earnings information needed by the Railroad Retirement Board to determine possible reductions in annuities because of earnings.

---

Authorizing Statute(s): US Code: 45 USC 231(a) Name of Law: Railroad Retirement Act
   US Code: 45 USC 231(f) Name of Law: Railroad Retirement Act
   PL: Pub.L. 100 - 647 7303 Name of Law: Technical and Miscellaneous Revenue Act of 1988
  

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:
	80 FR 3266	01/22/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 18446	04/06/2015
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment	G-19L	Annual Earnings Questionnaire

---

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	300	300	0	0	0	0
Annual Time Burden (Hours)	75	75	0	0	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: No

Burden Reduction Due to:

Short Statement:

---

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

---

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: 04/10/2015

---