APPLICATION AND CLAIM FOR SICKNESS INSURANCE BENEFITS

ICR 199108-3220-002

OMB: 3220-0039

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
157399 Migrated
ICR Details
3220-0039 199108-3220-002
Historical Active 199005-3220-003
RRB
APPLICATION AND CLAIM FOR SICKNESS INSURANCE BENEFITS
Revision of a currently approved collection   No
Regular
Approved without change 10/25/1991
Retrieve Notice of Action (NOA) 08/28/1991
  Inventory as of this Action Requested Previously Approved
10/31/1994 10/31/1994 07/31/1993
403,480 0 412,550
36,732 0 19,579
0 0 0

UNDER SECTION 2 OF THE RAILROAD UNEMPLOYMENT INSURANCE ACT, SICKNESS BENEFITS ARE PROVIDED FOR QUALIFIED RAILROAD WORKERS. THE COLLECTION OBTAINS INFORMATION NEEDED FOR DETERMINING ELIGIBILITY FOR AND AMOUNT OF SUCH BENEFITS.

None
None


No

1
IC Title Form No. Form Name
APPLICATION AND CLAIM FOR SICKNESS INSURANCE BENEFITS SI-1A/1B, SI-3, SI-7, SI-7A, ID-7H, ID-11A

  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 403,480 412,550 0 -9,070 0 0
Annual Time Burden (Hours) 36,732 19,579 0 17,153 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
08/28/1991


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