MEDICAL REPORTS

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
157384	MEDICAL REPORTS Form	Migrated

ICR Details

OMB Control No: 3220-0038	ICR Reference No: 198012-3220-001
Status: Historical Inactive	Previous ICR Reference No: 198011-3220-009
Agency/Subagency: RRB	Agency Tracking No:
Title: MEDICAL REPORTS
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Disapproved	Conclusion Date: 02/05/1981
	Date Received in OIRA: 12/31/1980
Terms of Clearance: IN DECEMBER 1979 THE G-3EMP, 250, 253A AND 257 WERE APPROVED FOR SIX MONTHS ONLY, UNTIL JUNE 1980, "TO ALLOW RRB TIME TO REVISE ALL OF ITS FORMS REQUESTING MEDICAL DATA, INCLUDING G-3EMP. G-250, G-253A AND G-257, TO BE SIMILAR TO THOSE IN USE BY SSA. SSA'S FORMS BASICALLY REQUEST ONLY MEDICAL DATA RELEVANT TO THE DETERMINATION OF DISABILITY VERSUS A MORE COMPLETE PHYSICAL REPORT." FINALLY, ON DECEMBER 31, 198 RRB REQUESTED APPROVAL TO CONTINUE TO USE THE G-3EMP AND 250, WITH SOM REVISION, AND TO USE A RL-11B FORM. THIS REQUEST IS DISAPPROVED. RRB SHOULD QUICKLY SUBMIT A REVISED PACKAGE, ESPECIALLY A REVISED G-250, WITH UNNECESSARY QUESTIONS, SUCH AS THE QUESTIONS ON AGE, HEIGHT, WEIGHT, SEX, TEMPERATURE, VISION, HEARING, URINANALYSIS RESULTS, AND BLOOD TEST RESULTS, ON THE G-250, DELETED.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		12/31/1980
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: SECTION 2 OF THE RAILROAD RETIREMENT ACT PROVIDES FOR THE PAYMENT OF DISABILITY ANNUITIES TO QUALIFIED RAILROAD EMPLOYEES WHO ARE UNABLE TO WORK IN THEIR REGULAR OCCUPATION (OCCUPATIONAL DISABILITY) OR ANY OCCUPATION (TOTAL DISABILITY). THE MEDICAL REPORTS ARE NEEDED TO DETERMINE THE EMPLOYEE'S ENTITLEMENT TO A DISABILITY ANNUITY.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
MEDICAL REPORTS	G-3RMP,, G-250,, G-253A,, G-257, G-3EMP, G-250, G-253A, G-257

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Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 12/31/1980

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