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Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment
Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment
OMB: 3220-0179
IC ID: 33989
OMB.report
RRB
OMB 3220-0179
ICR 201805-3220-002
IC 33989
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0179 can be found here:
2022-04-29 - No material or nonsubstantive change to a currently approved collection
2021-06-30 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form G-19L
Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment
Form
G-19L Annual Earnings Questionnaire
Form G-19L (08-12).pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 230.1
20 CFR 230.2
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
G-19L
Annual Earnings Questionnaire
Form G-19L (08-12).pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
RRB-22, Railroad Retirement, Survivor, and Pensioner Benefit System
FR Citation:
79 FR 58874
Number of Respondents:
300
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
300
0
0
0
0
300
Annual IC Time Burden (Hours)
75
0
0
0
0
75
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.