Application for Spouse Annuity Under the Railroad Retirement Act

OMB: 3220-0042

IC ID: 33861

Documents and Forms

Document Name Document Type
Form AA-3cert (all poss Application for Spouse Annuity Under the Railroad Retirement Act Form and Instruction
AA-3cert (all poss Application Summary and Certification Form AA-3cert (10-21) All Possible.pdf Form and Instruction
AA-3cert (all poss Application Summary and Certification Form AA-3cert (10-21) All Possible.pdf Form and Instruction
AA-3cert (complete Application Summary and Certification Form AA-3cert (10-21) Completed.pdf Form
AA-3cert (complete Application Summary and Certification Form AA-3cert (10-21) Completed.pdf Form
AA-3sum (all possi Application Summary Form AA-3sum (10-21) All Possible.pdf Form
AA-3sum (all possi Application Summary Form AA-3sum (10-21) All Possible.pdf Form
AA-3sum (completed Application Summary Form AA-3sum (10-21) Completed.pdf Form
AA-3sum (completed Application Summary Form AA-3sum (10-21) Completed.pdf Form
RB-3 (03-19).pdf RB-3, Furnishing Evidence To Support Your Claim IC Document
RB-3 (03-19).pdf RB-3, Furnishing Evidence To Support Your Claim IC Document
Form RB-30 (04-16).pdf RB-30, Spouse/Divorced Spouse Annuity IC Document
Form RB-30 (04-16).pdf RB-30, Spouse/Divorced Spouse Annuity IC Document
RB-9 (07-19).pdf RB-9, Employee and Spouse Annuities - Events That Must Be Reported IC Document
RB-9 (07-19).pdf RB-9, Employee and Spouse Annuities - Events That Must Be Reported IC Document
Form AA-7 (01-18).pdf AA-7, Spouse/Divorced Application for Medicare IC Document
Form AA-7 (01-18).pdf AA-7, Spouse/Divorced Application for Medicare IC Document
Form G-208 (02-17).pdf G-208, Public Service Pension Questionnaire IC Document
Form G-208 (02-17).pdf G-208, Public Service Pension Questionnaire IC Document
Form AA-3 (07-17).pdf AA-3, Application for Spouse/Divorced Spouse Annuity IC Document
Form AA-3 (07-17).pdf AA-3, Application for Spouse/Divorced Spouse Annuity IC Document
Form AA-3rec (04-13).pdf AA-3rec, Receipt for Claim IC Document
Form AA-3rec (04-13).pdf AA-3rec, Receipt for Claim IC Document
Form RL-1 (08-18).pdf RL-1 IC Document
Form RL-1 (08-18).pdf RL-1 IC Document
G-77a - (11-20).pdf G-77a (11-18) IC Document
G-77a - (11-20).pdf G-77a (11-18) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Spouse Annuity Under the Railroad Retirement Act	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 216.50 20 CFR 218.11

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	AA-3cert (all possible)	Application Summary and Certification	Form AA-3cert (10-21) All Possible.pdf	Yes	Yes	Fillable Printable
Form	AA-3cert (completed)	Application Summary and Certification	Form AA-3cert (10-21) Completed.pdf	Yes	Yes	Fillable Printable
Form	AA-3sum (all possible)	Application Summary	Form AA-3sum (10-21) All Possible.pdf	Yes	Yes	Fillable Printable
Form	AA-3sum (completed)	Application Summary	Form AA-3sum (10-21) Completed.pdf	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records
Title: RRB-22, Railroad Retirement, Survivor and Pensioner Benefit System	FR Citation: 79 FR 58874

Number of Respondents: 9,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	9,700	-1,300	11,000
Annual IC Time Burden (Hours)	4,791	-632	5,423
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
RB-3, Furnishing Evidence To Support Your Claim	RB-3 (03-19).pdf	04/21/2022
RB-30, Spouse/Divorced Spouse Annuity	Form RB-30 (04-16).pdf	12/21/2018
RB-9, Employee and Spouse Annuities - Events That Must Be Reported	RB-9 (07-19).pdf	04/21/2022
AA-7, Spouse/Divorced Application for Medicare	Form AA-7 (01-18).pdf	04/21/2022
G-208, Public Service Pension Questionnaire	Form G-208 (02-17).pdf	12/21/2018
AA-3, Application for Spouse/Divorced Spouse Annuity	Form AA-3 (07-17).pdf	12/21/2018
AA-3rec, Receipt for Claim	Form AA-3rec (04-13).pdf	12/21/2018
RL-1	Form RL-1 (08-18).pdf	03/01/2019
G-77a (11-18)	G-77a - (11-20).pdf	04/21/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.