Statement of Claimant or Other Person

ICR 200009-3220-001

OMB: 3220-0183

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
33992 Migrated
ICR Details
3220-0183 200009-3220-001
Historical Active 199710-3220-001
RRB
Statement of Claimant or Other Person
Extension without change of a currently approved collection   No
Regular
Approved without change 10/30/2000
Retrieve Notice of Action (NOA) 09/05/2000
  Inventory as of this Action Requested Previously Approved
10/31/2003 10/31/2003 11/30/2000
900 0 900
225 0 225
0 0 0

Under Section 2 of the Railroad Retirement Act and the Railroad Unemployment Insurance Act, pertinent information and proofs must be submitted by an applicant so that the Railroad Board can determine his or her entitlement to benefits. The collection obtains information supplementing or changing information previously provided by an applicant.

None
None


No

1
IC Title Form No. Form Name
Statement of Claimant or Other Person G-93

  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 900 900 0 0 0 0
Annual Time Burden (Hours) 225 225 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.
09/05/2000


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