03-3641. Agency Forms Submitted for OMB Review

Summary:

In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35), the Railroad Retirement Board (RRB) has submitted the following proposal(s) for the collection of information to the Office of Management and Budget for review and approval.

Summary of Proposal(s)

(1) Collection title: Application for Survivor Death Benefits.

(2) Form(s) submitted: AA-21, AA-21cert, G-273a, AA-11a, and G-131.

(3) OMB Number: 3220-0031.

(4) Expiration date of current OMB clearance: 04/30/2003.

(5) Type of request: Extension of a currently approved collection.

(6) Respondents: Individuals or households, Business or other for-profit.

(7) Estimated annual number of respondents: 20,600.

(8) Total annual responses: 20,600.

(9) Total annual reporting hours: 5,150.

(10) Collection description: The collection obtains the information needed to pay death benefits and annuities due but unpaid at death under the Railroad Retirement Act. Benefits are paid to designated beneficiaries or to survivors in a priority designated by law.

Additional Information or Comments: Copies of the forms and supporting documents can be obtained from Chuck Mierzwa, the agency clearance officer (312-751-3363).

Comments regarding the information collection should be addressed to Ronald J. Hodapp, Railroad Retirement Board, 844 North Rush Street, Chicago, Illinois, 60611-2092 and to the OMB Desk Officer for the RRB, at the Office of Management and Budget, Room 10230, New Executive Office Building, Washington, DC 20503.

Chuck Mierzwa,

Clearance Officer.