[Federal Register Volume 77, Number 216 (Wednesday, November 7, 2012)]
[Notices]
[Pages 66877-66880]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-27114]


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RAILROAD RETIREMENT BOARD


Agency Forms Submitted for OMB Review, Request for Comments

SUMMARY: In accordance with the Paperwork Reduction Act of 1995 (44 
U.S.C. Chapter 35), the Railroad Retirement Board (RRB) is forwarding 
three Information Collection Requests (ICR) to the Office of 
Information and Regulatory Affairs (OIRA), Office of Management and 
Budget (OMB). Our ICR describes the information we seek to collect from 
the public. Review and approval by OIRA ensures that we impose 
appropriate paperwork burdens.
    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 
Information and electronic Form

[[Page 66878]]

AA-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:

----------------------------------------------------------------------------------------------------------------
                                                                      Annual           Time           Burden
                            Form No.                                 responses       (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
AA-1 (without assistance).......................................             100              62             103
AA-1cert (with assistance)......................................           4,900              30           2,450
AA-1d (with assistance).........................................           3,700              35           2,158
AA-1d (without assistance)......................................               5              60               5
AA-1sum (with assistance).......................................           9,100              29           4,398
G-204...........................................................              20              15               5
                                                                 -----------------------------------------------
    Total.......................................................          17,825  ..............           9,119
----------------------------------------------------------------------------------------------------------------

    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 Summary

[[Page 66879]]

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-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:

----------------------------------------------------------------------------------------------------------------
                                                                      Annual           Time           Burden
                            Form No.                                 responses       (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
AA-17 (without assistance)......................................             100              47              78
AA-17b (with assistance)........................................             280              40             187
AA-17b (without assistance).....................................              20              50              17
AA-17cert (with assistance).....................................             900              20             300
AA-17sum (with assistance)......................................           2,100              19             665
AA-18 (without assistance)......................................              12              47               9
AA-19 (without assistance)......................................               9              47               7
AA-19a (with assistance)........................................             285              45             214
AA-19a (without assistance).....................................              15              65              16
AA-20 (without assistance)......................................               1              47               1
                                                                 -----------------------------------------------
      Total.....................................................           3,722  ..............           1,494
----------------------------------------------------------------------------------------------------------------

    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 is

[[Page 66880]]

correct; 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:

----------------------------------------------------------------------------------------------------------------
                                                                      Annual           Time           Burden
                            Form No.                                 responses       (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
AA-3 (without assistance).......................................             250              58             242
AA-3cert (with assistance)......................................           3,700              30           1,850
AA-3sum (with assistance).......................................           7,100              29           3,432
                                                                 -----------------------------------------------
    Total.......................................................          11,050  ..............           5,524
----------------------------------------------------------------------------------------------------------------

    Additional Information or Comments: Copies of the forms and 
supporting documents can be obtained from Dana Hickman at (312) 751-
4981 or [email protected].
    Comments regarding the information collection should be addressed 
to Charles Mierzwa, Railroad Retirement Board, 844 North Rush Street, 
Chicago, Illinois 60611-2092 or [email protected] and to the OMB 
Desk Officer for the RRB, Fax: 202-395-6974, Email address: [email protected].

Charles Mierzwa,
Chief of Information Resources Management.
[FR Doc. 2012-27114 Filed 11-6-12; 8:45 am]
BILLING CODE 7905-01-P