Statement Regarding Contributions and Support

OMB 3220-0099

OMB 3220-0099

Dependency on the employee for one-half support at the time of the employee's death can be a condition affecting eligibility for a survivor annuity provided for under Section 2 of the Railroad Retirement Act. One-half support is also a condition which may negate the public service pension offset in Tier I for a spouse or widow(er).

The latest form for Statement Regarding Contributions and Support expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form
Supporting Statement A
All Historical Document Collections
 Revision of a currently approved collection 2024-05-21
Revision of a currently approved collection 2020-11-24
Approved without change
 Extension without change of a currently approved collection 2017-09-20
Approved without change
 Extension without change of a currently approved collection 2014-08-05
Approved without change
 Extension without change of a currently approved collection 2011-07-21
Approved without change
 Extension without change of a currently approved collection 2008-05-23
Approved without change
 Extension without change of a currently approved collection 2005-05-26
Approved without change
 Extension without change of a currently approved collection 2002-04-26
Approved without change
 Revision of a currently approved collection 1999-04-19
Approved without change
 No material or nonsubstantive change to a currently approved collection 1999-02-23
Approved without change
 Extension without change of a currently approved collection 1995-12-29
Approved without change
 No material or nonsubstantive change to a currently approved collection 1995-09-30
Approved without change
 Extension without change of a currently approved collection 1992-09-24
Approved without change
 Extension without change of a currently approved collection 1989-07-31
Approved with change
 No material or nonsubstantive change to a currently approved collection 1989-04-07
Approved with change
 No material or nonsubstantive change to a currently approved collection 1989-04-04
Approved without change
 Extension without change of a currently approved collection 1986-07-23
Approved without change
 Revision of a currently approved collection 1983-08-17
Approved with change
 No material or nonsubstantive change to a currently approved collection 1981-05-28
Approved without change
 Revision of a currently approved collection 1980-05-28
Approved without change
 Extension without change of a currently approved collection 1979-04-27
Approved without change
 Extension without change of a currently approved collection 1979-03-14
Approved without change
 Extension without change of a currently approved collection 1978-03-31
Approved without change
 Extension without change of a currently approved collection 1978-03-06
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