CLAIM'S AGENTS AND CLAIMANT'S STATEMENT RE: BENEFITS FOR DAYS WORKED BY CLAIMANTS

ICR 198004-3220-011

OMB: 3220-0081

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3220-0081 198004-3220-011
Historical Active 198003-3220-018
RRB
CLAIM'S AGENTS AND CLAIMANT'S STATEMENT RE: BENEFITS FOR DAYS WORKED BY CLAIMANTS
No material or nonsubstantive change to a currently approved collection   No
Emergency 04/22/1980
Approved with change 04/22/1980
Retrieve Notice of Action (NOA) 04/22/1980
  Inventory as of this Action Requested Previously Approved
12/31/1980 12/31/1980 12/31/1980
1,200 0 1,200
200 0 200
0 0 0

IN ADMINISTERING THE PROVISIONS OF THE RAILROAD UNEMPLOYMENT INSURANCE ACT, THE BOARD UNDERTAKES FRAUD INVESTIGATIONS. THE STATEMENTS WILL OBTAIN INFORMATION FROM THE CLAIMS AGENT AND THE CLAIMANT ABOUT THE CIRCUMSTANCES INVOLVED IN THE CLAIMS FOR THE BENEFITS. THE INFORMATION WILL BE USED TO DETERMINE IF THERE WAS A DELIBERATE VIOLATION OF THE RAILROAD UNEMPLOYMENT INSURANCE ACT.

None
None


No

1
IC Title Form No. Form Name
CLAIM'S AGENTS AND CLAIMANT'S STATEMENT RE: BENEFITS FOR DAYS WORKED BY CLAIMANTS UI-48,, UI-54

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,200 1,200 0 0 0 0
Annual Time Burden (Hours) 200 200 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/22/1980


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