OMB
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Search
Evidence of Marital Relationship - Living with Requirements
Evidence of Marital Relationship - Living with Requirements
OMB: 3220-0021
IC ID: 33823
OMB.report
RRB
OMB 3220-0021
ICR 202507-3220-001
IC 33823
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Evidence of Marital Relationship - Living with Requirements
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 219.3
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
G-124 (03-23)
Statement of Marital Relationship
G-124 (03-23).pdf
No
Paper Only
Form
G-124A (03-23)
Statement Regarding Marriage
G-124A (03-23).pdf
No
Paper Only
Form and Instruction
G-237 (03-203
Statement Regarding Marital Status
G-237 (03-23).pdf
No
Paper Only
Form
G-238A (07-20)
Statement Regarding Divorce or Annulment
Form G-238A (07-20).pdf
No
Paper Only
Form
G-238 (07-20)
Statement of Residence
Form G-238 (07-20).pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
RRB-22; Railroad Retirement, Survivor and Pensioner Benefit System
FR Citation:
79 FR 58874
Number of Respondents:
1,100
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,100
0
0
0
0
1,100
Annual IC Time Burden (Hours)
196
0
0
0
0
196
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Notice of Information Needed in Claim under Railroad Retirement Act
Form G-242 (01-07).pdf
01/24/2012
RL-26, Transmittal Letter, Instruction Sheet
Form RL-26F (05-08).pdf
01/24/2012
RL-57A-F, Transmittal letter
Form RL-57A-F (10-82).pdf
01/24/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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