REQUESTS FOR CONSULTATIVE MEDICAL EXAMINATIONS

ICR 198505-3220-003

OMB: 3220-0124

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
157691 Migrated
ICR Details
3220-0124 198505-3220-003
Historical Active 198407-3220-002
RRB
REQUESTS FOR CONSULTATIVE MEDICAL EXAMINATIONS
Revision of a currently approved collection   No
Regular
Approved without change 06/20/1985
Retrieve Notice of Action (NOA) 05/15/1985
  Inventory as of this Action Requested Previously Approved
06/30/1988 06/30/1988 12/31/1985
10,500 0 10,000
10,500 0 10,000
0 0 0

UNDER SECTION 2 OF THE RRA AND SECTION 2 OF THE RUIA DISABILITY AND SICKNESS BENEFITS ARE RESPECTIVELY PROVIDED FOR QUALIFIED RAILROAD EMPLOYEES. THE COLLECTION OBTAINS CONSULTATIVE EVIDENCE OF INABILITY TO WORK WHEN NEEDED TO SUPPLEMENT EVIDENCE OBTAINED FROM OTHER SOURCES

None
None


No

1
IC Title Form No. Form Name
REQUESTS FOR CONSULTATIVE MEDICAL EXAMINATIONS RL-12/ID-31A

  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 10,500 10,000 0 0 500 0
Annual Time Burden (Hours) 10,500 10,000 0 0 500 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.
05/15/1985


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