Information Collection

Referral Card - Report On Placement Or Refusal Of Referral Or Offer To Railroad Retirement Board

IC 176920 under ICR 198104-3220-007 · OMB 3220-0027.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

REFERRAL CARD - REPORT ON PLACEMENT OR REFUSAL OF REFERRAL OR OFFER TO RAILROAD RETIREMENT BOARD

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	ES-21,	No	No
Form	ES-21C	No	No
Form	ES-21C	No	No
Form	ES-21 &	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 21,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	26,000	5,000	21,000
Annual IC Time Burden (Hours)	883	0	883
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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