REPORT OF PHYSICAL CONDITION OF CLAIMANT UNDER RUIA

ICR 198011-3220-010

OMB: 3220-0035

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
176951 Migrated
ICR Details
3220-0035 198011-3220-010
Historical Active 198008-3220-009
RRB
REPORT OF PHYSICAL CONDITION OF CLAIMANT UNDER RUIA
No material or nonsubstantive change to a currently approved collection   No
Emergency 11/25/1980
Approved with change 11/25/1980
Retrieve Notice of Action (NOA) 11/25/1980
  Inventory as of this Action Requested Previously Approved
12/31/1980 12/31/1980 11/30/1980
1,500 0 1,500
125 0 125
0 0 0

THE RAILROAD UNEMPLOYMENT INSURANCE ACT PROVIDES THAT A RAILROAD EMPLOYEE APPLIYING FOR SICKNESS BENEFITS MUST OBTAIN A MEDICAL REPORT OF HIS OR HER PHYSICAL CONDITION. THE INFORMATION ON THE CLAIMANT'S PHYSICAL CONDITION WILL BE USED TO SUPPORT THE APPLICATION FOR SICKNESS BENEFITS.

None
None


No

1
IC Title Form No. Form Name
REPORT OF PHYSICAL CONDITION OF CLAIMANT UNDER RUIA SI-34

  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 1,500 1,500 0 0 0 0
Annual Time Burden (Hours) 125 125 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.
11/25/1980


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