Survivor Questionnaire

ICR 202308-3220-007

OMB: 3220-0032

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Unchanged
Justification for No Material/Nonsubstantive Change
2023-08-24
Supporting Statement A
2022-09-20
Supplementary Document
2019-09-26
Supplementary Document
2019-09-26
IC Document Collections
IC ID
Document
Title
Status
33842 Unchanged
ICR Details
3220-0032 202308-3220-007
Active 202209-3220-002
RRB
Survivor Questionnaire
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 08/24/2023
Retrieve Notice of Action (NOA) 08/24/2023
  Inventory as of this Action Requested Previously Approved
01/31/2026 01/31/2026 01/31/2026
5,450 0 5,450
959 0 959
0 0 0

Under Section 6 of the Railroad Retirement Act, benefits are payable to the survivors or the estates of deceased railroad employees. The collection obtains information used to determine if and to whom benefits are payable; such as a widow(er) due survivor benefits, an executor of the estate, or a payer of burial expenses.

US Code: 45 USC 231(f) et seq. Name of Law: Railroad Retirement Act
  
None

Not associated with rulemaking

  87 FR 42217 07/14/2022
87 FR 57526 09/20/2022
No

1
IC Title Form No. Form Name
Survivor Questionnaire RL-94F (XX-XX), RL-94F (10-18) Survivor Questionnaire ,   Survivor Questionnaire

  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 5,450 5,450 0 0 0 0
Annual Time Burden (Hours) 959 959 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$10,609
No
    Yes
    Yes
No
No
No
No
Brian Foster 312 751-4826 brian.foster@rrb.gov

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/24/2023


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