REPORT OF PAYMENTS TO EMPLOYEE CLAIMING SICKNESS BENEFITS UNDER THE RUIA

ICR 198105-3220-009

OMB: 3220-0036

Federal Form Document

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ICR Details
3220-0036 198105-3220-009
Historical Active 198103-3220-017
RRB
REPORT OF PAYMENTS TO EMPLOYEE CLAIMING SICKNESS BENEFITS UNDER THE RUIA
No material or nonsubstantive change to a currently approved collection   No
Emergency 05/28/1981
Approved with change 05/28/1981
Retrieve Notice of Action (NOA) 05/28/1981
  Inventory as of this Action Requested Previously Approved
09/30/1982 09/30/1982 05/31/1981
5,000 0 5,000
417 0 417
0 0 0

SECTION 12(O) OF THE RAILROAD UNEMPLOYMENT INSURANCE ACT PROVIDES FOR REIMBURSEMENT OF SICKNESS BENEFITS PAID UNDER THE ACT IF THE EMPLOYEE RECEIVES A SETTLEMENT FOR THE SAME INJURY FOR WHICH SUCH BENEFITS WERE PAID. THE REPORT OF PERSONAL INJURY FOR WHICH SUCH BENEFITS WERE PAID. THE REPORT OF PERSONAL INJURY SETTLEMENT WILL OBTAIN THE INFORMATION NEEDED FOR DETERMINING THE AMOUNT OF REIMBURSEMENT THE BOARD IS ENTITLED TO UNDER THE ACT

None
None


No

1
IC Title Form No. Form Name
REPORT OF PAYMENTS TO EMPLOYEE CLAIMING SICKNESS BENEFITS UNDER THE RUIA SI-5

  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 5,000 5,000 0 0 0 0
Annual Time Burden (Hours) 417 417 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.
05/28/1981


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