Railroad Unemployment Insurance Act Applications

Forms and Documents

Document Name	Status
Form ID-11A (proposed) Railroad Unemployment Insurance Act Applications Form and Instruction	Modified
Form SI-1b Railroad Unemployment Insurance Act Applications Form and Instruction	New
3220-0039.doc Supporting Statement A	0000-00-00

IC Document Collections

IC ID	Document Title	Status
33857	Railroad Unemployment Insurance Act Applications Form and Instruction	Modified
179107	Railroad Unemployment Insurance Act Applications Form and Instruction	New

ICR Details

OMB Control No: 3220-0039	ICR Reference No: 200703-3220-001
Status: Historical Active	Previous ICR Reference No: 200401-3220-002
Agency/Subagency: RRB	Agency Tracking No:
Title: Railroad Unemployment Insurance Act Applications
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/29/2007
	Date Received in OIRA: 03/23/2007
Terms of Clearance: Pursuant to OMB Memorandum dated May 22, 2007 (M-07-16) and the Identity Theft Task Force, steps should be taken to reduce the risks of data breach incidents of personally identifiable information. This Paperwork Reduction Act collection requests the Social Security Number (SSN) of individual [beneficiaries]. OMB is approving this information collection for 18 months to allow [RRB] to gather information concerning the use and need of individual SSNs. Upon resubmission of the information collection to OMB, please provide a written explanation of the following: 1. Authority for collecting the SSN (e.g. statutory requirement or other legal requirement). 2. Explanation for the use of the SSN on the form (e.g. identity verification, etc.) 3. Alternative method(s) (other than the use of a SSN) for verifying the identity of an individual for the purposes of carrying out the information collection requirement. 4. The cost and systems redesign that would be required to remove the use of the SSN and implement the alternate method(s) of verifying individual identities. This analysis should estimate costs to the program each year over 5 years.” RRB will also make sure that burden changes are classified accurately in future submissions of all ICRs as either "adjustments" or "due to agency discretion."

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2008	36 Months From Approved	06/30/2007
Responses	248,900	0	260,900
Time Burden (Hours)	25,351	0	26,321
Cost Burden (Dollars)	0	0	0

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Abstract: Under Section 2 of the Railroad Unemployment Insurance Act, sickness benefits are payable to qualified railroad employees who are unable to work because of illness or injury. The collection obtains information from railroad employees and physicians needed to determine eligibility to and the amount of such benefits.

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Authorizing Statute(s): US Code: 45 USC 362 (i) Name of Law: Railroad Unemploment Insurance Act
   US Code: 45 USC 362(n) Name of Law: Railroad Unemployment Insurance Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 71198	12/08/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 13314	03/21/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Railroad Unemployment Insurance Act Applications	ID-11A (proposed), SI-1a, SI-3 , ID-7H, ID-11A, ID-11B , ID-11B (Proposed), SI-1A (proposed)	Requesting Reason for Late Filing of Sickness Benefit ,   Application for Sickness Benefits ,   Claim for Sickness Benefits ,   Non-Entitlement to Sickness Benefits and Information on Unemployment Insurance Benefits ,   Requesting Reason for Late Filing of Sickness Benefit ,   Notice of Insufficient Medical and Late Filing ,   Application for Sickness Benefits ,   Notice of Insufficient Medical and Late Filing
Railroad Unemployment Insurance Act Applications	SI-8, SI-7, SI-1b	Statement of Sickness ,   Supplemental Doctor's Statement ,   Verification of Medical Information

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ICR Summary of Burden

	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	248,900	260,900	0	-12,000	0	0
Annual Time Burden (Hours)	25,351	26,321	0	-970	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Enhanced RRB program tracking capabilities allows the RRB to reduce the estimate of Form SI-3’s filed to reflect actual usage resulting in a decline of 12,000 responses and 1,000 hours of burden. The RRB increased the estimated completion time of Form(s) ID-11a and ID-11b from 3 to 4 minutes due to the additional question, resulting in a burden increase of 30 hours. Overall, the total burden reduction for the collection is 12,000 annual responses and 970 burden hours.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/23/2007

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