Application and Claim for Sickness Benefits

ICR 199802-3220-001

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
33855 Migrated
ICR Details
3220-0039 199802-3220-001
Historical Active 199501-3220-001
RRB
Application and Claim for Sickness Benefits
Revision of a currently approved collection   No
Regular
Approved without change 04/15/1998
Retrieve Notice of Action (NOA) 02/20/1998
  Inventory as of this Action Requested Previously Approved
04/30/2001 04/30/2001 04/30/1998
270,900 0 333,600
27,921 0 33,591
0 0 0

Under section 2 of the Railroad Unemployment Insurance Act, sickness benefits are provided for qualified railroad employees. The collection obtains information from employees and physicians 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 Benefits SI-1A, SI-1B, SI-3, SI-7, SI-8, 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 270,900 333,600 0 4,722 -67,422 0
Annual Time Burden (Hours) 27,921 33,591 0 427 -6,097 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.
02/20/1998


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