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Daily Rules, Proposed Rules, and Notices of the Federal Government

RAILROAD RETIREMENT BOARD

Agency Forms Submitted for OMB Review, Request for Comments

SUMMARY: The RRB invites comments on the proposed collections of information to determine (1) the practical utility of the collections; (2) the accuracy of the estimated burden of the collections; (3) ways to enhance the quality, utility, and clarity of the information that is the subject of collection; and (4) ways to minimize the burden of collections on respondents, including the use of automated collection techniques or other forms of information technology. Comments to the RRB or OIRA must contain the OMB control number of the ICR. For proper consideration of your comments, it is best if the RRB and OIRA receive them within 30 days of the publication date.

1. Title and purpose of information collection:Application for Employee Annuity Under the Railroad Retirement Act; OMB 3220-0002.

Section 2a of the Railroad Retirement Act (RRA) provides for payments of age and service, disability, and supplemental annuities to qualified employees. An annuity cannot be paid until the employee stops working for a railroad employer. In addition, the age and service employee must relinquish any rights held to such a job. A disabled employee does not need to relinquish employee rights until attaining Full Retirement Age, or if earlier, when their spouse files for a spouse annuity. Benefits become payable after the employee meets certain other requirements, which depend on the type of annuity payable. The requirements for obtaining the annuities are prescribed in 20 CFR 216 and 220.

To collect the information needed to help determine an applicant's entitlement to, and the amount of, an employee retirement annuity the RRB uses Forms AA-1,Application for Employee Annuity;AA-1d,Application for Determination of Employee Disability;G-204,Verification of Workers Compensation/Public Disability Benefit Informationand electronic FormAA-1cert,Application Summary and Certification.

The AA-1 application process obtains information from an applicant about their marital history, work history, military service, benefits from other governmental agencies, railroad pensions and Medicare entitlement for either an age and service or disability annuity. An RRB representative interviews the applicant either at a field office (preferred), an itinerant point, or by telephone. During the interview, the RRB representative enters the information obtained into an on-line information system. Upon completion of the interview, the on-line information system generates, for the applicant's review and traditional pen and ink "wet" signature, Form AA-1cert,Application Summary and Certification,which summarizes the information that was provided or verified by the applicant. When the RRB representative is unable to contact the applicant in person or by telephone, for example, the applicant lives in another country, a manual version of Form AA-1 is used.

Form AA-1d,Application for Determination of Employee's Disability,is completed by an employee who is filing for a disability annuity under the RRA, or a disability freeze under the Social Security Act, for early Medicare based on a disability. Form G-204,Verification of Worker's Compensation/Public Disability Benefit Information,is used to obtain and verify information concerning a worker's compensation or a public disability benefit that is or will be paid by a public agency to a disabled railroad employee.

Consistent with 20 CFR 217.17, upon completion of the AA-1 interview process, the RRB proposes to provide, in addition to the current Form AA-1cert pen and ink "wet" signature, an alternate signing method called "Attestation," which will be documented by new Form AA-1sum,Application Summary.Attestation refers to an action taken by the RRB representative to confirm and annotate in the RRB records (1) the applicant's intent to file an application; (2) the applicant's affirmation under penalty of perjury that the information provided is correct; and (3) the applicant's agreement to sign the application by proxy. The information collected as part of the AA-1 interview process will be the same irrespective of whether the application is signed by a pen and ink "wet" signature or by attestation. The only difference will be the method of signature.

In addition, consistent with Department of Treasury guidelines, the RRB proposes revisions to Forms AA-1 and AA-1cert to provide claimants a debit card payment option. Other non-burden-impacting editorial and formatting changes are proposed. One response is requested of each respondent. Completion of the forms is required to obtain a benefit.

Previous Requests for Comments:The RRB has already published the initial 60-day notice (77 FR 1093 on January 9, 2012) required by 44 U.S.C. 3506(c)(2). That request elicited no comments.

Information Collection Request (ICR)

Title:Application for Employee Annuity Under the Railroad Retirement Act.

OMB Control Number:3220-0002.

Form(s) submitted:AA-1, AA-1cert, AA-1d, AA-1sum and G-204.

Type of request:Revision of a currently approved collection.

Affected public:Individuals or Households.

Abstract:The Railroad Retirement Act provides for payment of age, disability and supplemental annuities to qualified employees. The application and related forms obtain information about the applicant's family work history, military service, disability benefits from other government agencies and public or private pensions. The information is used to determine entitlement to and the amount of the annuity applied for.

Changes proposed:The RRB proposes revisions to Forms AA-1 and AA-1cert to provide claimants with a debit card payment option. The RRB also proposes the creation of Form AA-1sum, Application Summary, which will be produced at the end of the AA-1 interview process for documenting the alternate signing method called "Attestation." The RRB proposes no revisions to Forms AA-1d or G-204.

The burden estimate for the ICR is as follows:

2. Title and purpose of information collection:Application for Survivor Insurance Annuities; OMB 3220-0030.

Under Section 2(d) of the Railroad Retirement Act (RRA), monthly survivor annuities are payable to surviving widow(er)s, parents, unmarried children, and in certain cases, divorced spouses, mothers (fathers), remarried widow(er)s, and grandchildren of deceased railroad employees if there are no qualified survivors of the employee immediately eligible for an annuity. The requirements relating to the annuities are prescribed in 20 CFR 216, 217, 218, and 219.

To collect the information needed to help determine an applicant's entitlement to, and the amount of, a survivor annuity the RRB uses Forms AA-17,Application for Widow(er)'s Annuity;AA-17b,Applications for Determination of Widow(er)'s Disability;AA-18,Application for Mother's/Father's and Child's Annuity;AA-19,Application for Child's Annuity;AA-19a,Application for Determination of Child's Disability;AA-20,Application for Parent's Annuity,and electronic Form AA-17cert,Application Summary and Certification.

The AA-17 application process obtains information from an applicant about their marital history, work history, benefits from other government agencies, and Medicare entitlement for a survivor annuity. An RRB representative interviews the applicant either at a field office (preferred), an itinerant point, or by telephone. During the interview, the RRB representative enters the information obtained into an on-line information system. Upon completion of the interview, the system generates, for the applicant's review and traditional pen and ink "wet" signature, Form AA-17cert,Application Summaryand Certification,which is a summary of the information that the applicant provided or verified. When the RRB representative is unable to contact the applicant in person or by telephone, for example, the applicant lives in another country, a manual version of Form AA-17 is used.

Consistent with 20 CFR 217.17, upon completion of the AA-17 interview process, the RRB proposes to provide, in addition to the current Form AA-17cert pen and ink "wet" signature, an alternate signing method called "Attestation," which will be documented by new Form AA-17sum,Application Summary.Attestation refers to an action taken by the RRB representative to confirm and annotate in the RRB records (1) the applicant's intent to file an application; (2) the applicant's affirmation under penalty of perjury that the information provided is correct; and (3) the applicant's agreement to sign the application by proxy. The information collected as part of the AA-17 interview process will be the same irrespective of whether the application is signed by a pen and ink "wet" signature or by attestation. The only difference will be the method of signature.

In addition, consistent with Department of Treasury guidelines, the RRB proposes revisions to Forms AA-17, AA-17cert, AA-18, AA-19, and AA-20cert to provide claimants a debit card payment option. Other non-burden-impacting editorial and formatting changes are proposed. No changes are proposed to Forms AA-17b and AA-19a. One response is requested of each respondent. Completion of the forms is required to obtain a benefit.

Previous Requests for Comments:The RRB has already published the initial 60-day notice (77 FR 1093 on January 9, 2012) required by 44 U.S.C. 3506(c)(2). That request elicited no comments.

Information Collection Request (ICR)

Title:Application for Survivor Insurance Annuities.

OMB Control Number:3220-0030.

Form(s) submitted:AA-17, AA-17b, AA-17cert, AA-17sum, AA-18, AA-19, AA-19a, and AA-20cert.

Type of request:Revision of a currently approved collection.

Affected public:Individuals or Households.

Abstract:Under Section 2(d) of the Railroad Retirement Act, monthly survivor annuities are payable to surviving widow(er)s, parents, unmarried children, and in certain cases, divorced wives (husbands), mothers (fathers), remarried widow(er)s and grandchildren of deceased railroad employees. The collection obtains information needed by the RRB for determining entitlement to and amount of the annuity applied for.

Changes proposed:The RRB proposes revisions to Forms AA-17, AA-17cert, AA-18, AA-19, and AA-20cert to provide claimants with a debit card payment option. The RRB also proposes the creation of Form AA-17sum,Application Summary,to be produced at the end of the AA-17 interview process for claimants who choose the alternate signing method called "Attestation." Other non-burden-impacting editorial and formatting changes are proposed. No changes are proposed to Forms AA-17b and AA-19a.

The burden estimate for the ICR is as follows:

3. Title and purpose of information collection:Application for Spouse Annuity Under the Railroad Retirement Act; OMB 3220-0042.

Section 2(c) of the Railroad Retirement Act (RRA), provides for the payment of annuities to spouses of railroad retirement annuitants who meet the requirements under the RRA. The age requirements for a spouse annuity depend on the employee's age, date of retirement, and years of railroad service. The requirements relating to the annuities are prescribed in 20 CFR 216, 218, 219, 232, 234, and 295.

To collect the information needed to help determine an applicant's entitlement to, and the amount of, a spouse annuity the RRB uses Form AA-3,Application for Spouse/Divorced Spouse Annuity,and electronic Form AA-3cert,Application Summary and Certification.

The AA-3 application process gathers information from an applicant about their marital history, work history, benefits from other government agencies, railroad pensions and Medicare entitlement for a spouse annuity. An RRB representative interviews the applicant either at a field office (preferred), an itinerant point, or by telephone. During the interview, the RRB representative enters the information obtained into an on-line information system. Upon completion of the interview, the system generates, for the applicant's review and traditional pen and ink "wet" signature, Form AA-3cert,Application Summary and Certification,which is a summary of the information that the applicant provided or verified. When the RRB representative is unable to contact the applicant in person or by telephone, for example, the applicant lives in another country, a manual version of Form AA-3 is used.

Consistent with 20 CFR 217.17, upon completion of the AA-3 interview process, the RRB proposes to provide, in addition to the current Form AA-3cert pen and ink "wet" signature, an alternate signing method called "Attestation," which will be documented by new form AA-3sum, Application Summary. Attestation refers to an action taken by the RRB representative to confirm and annotate in the RRB records (1) the applicant's intent to file an application; (2) the applicant's affirmation under penalty of perjury that the information provided iscorrect; and (3) the applicant's agreement to sign the application by proxy. The information collected as part of the AA-3 interview process will be the same irrespective of whether the application is signed by a pen and ink "wet" signature or by attestation. The only difference will be the method of signature.

In addition, consistent with Department of Treasury guidelines, the RRB proposes revisions to Forms AA-3 and AA-3cert to provide claimants a debit card payment option. Other non-burden-impacting editorial and formatting changes are proposed. One response is requested of each respondent. Completion of the forms is required to obtain a benefit.

Previous Requests for Comments:The RRB has already published the initial 60-day notice (77 FR 1093 on January 9, 2012) required by 44 U.S.C. 3506(c)(2). That request elicited no comments.

Information Collection Request (ICR)

Title:Application for Spouse Annuity Under the Railroad Retirement Act.

OMB Control Number:3220-0042.

Form(s) submitted:AA-3, AA-3cert, and AA-3sum.

Type of request:Revision of a currently approved collection.

Affected public:Individuals or Households.

Abstract:The Railroad Retirement Act provides for the payment of annuities to spouses of railroad retirement annuitants who meet the requirements under the Act. The application obtains information supporting the claim for benefits based on being a spouse of an annuitant. The information is used for determining entitlement to and amount of the annuity applied for.

Changes proposed:The RRB proposes revisions to Forms AA-3 and AA-3cert to provide claimants with a debit card payment option. The RRB also proposes the creation of Form AA-3sum,Application Summary,to be produced at the end of the AA-3 interview process for claimants who choose the alternate signing method called "Attestation." Other non-burden-impacting editorial and formatting changes are proposed.

The burden estimate for the ICR is as follows:

Additional Information or Comments:Copies of the forms and supporting documents can be obtained from Dana Hickman at (312) 751-4981 orDana.Hickman@RRB.GOV.

Comments regarding the information collection should be addressed to Charles Mierzwa, Railroad Retirement Board, 844 North Rush Street, Chicago, Illinois 60611-2092 orCharles.Mierzwa@RRB.GOVand to the OMB Desk Officer for the RRB, Fax: 202-395-6974, Email address:OIRA_Submission@omb.eop.gov.

Charles Mierzwa, Chief of Information Resources Management.