Information Collection

Railroad Unemployment Insurance Act Applications

IC 179107 under ICR 200703-3220-001 · OMB 3220-0039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0039 can be found here:

Documents and Forms

Document Name Document Type
Form SI-1b Railroad Unemployment Insurance Act Applications Form and Instruction
SI-1b Statement of Sickness SI-1b (02-01).pdf http:www.rrb.gov/pdf/PandS/ub11.pdf Form and Instruction
SI-7 Supplemental Doctor's Statement SI-7 (02-01).pdf Form and Instruction
SI-8 Verification of Medical Information SI-8 (02-01).pdf Form and Instruction
Form UB-11 (11-06).pdf Sickness Benefits for Railroad Employees IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Railroad Unemployment Insurance Act Applications	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 355

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SI-1b	Statement of Sickness	SI-1b (02-01).pdf	http:www.rrb.gov/pdf/PandS/ub11.pdf	Yes	No	Printable Only
Form and Instruction	SI-7	Supplemental Doctor's Statement	SI-7 (02-01).pdf		No		Paper Only
Form and Instruction	SI-8	Verification of Medical Information	SI-8 (02-01).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title: RRB-21, Railroad Unemployment and Sickness Insurance Benefit System	FR Citation: 40 FR 36275

Number of Respondents: 22,200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	55,850	55,850
Annual IC Time Burden (Hours)	7,444	7,444
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Sickness Benefits for Railroad Employees	Form UB-11 (11-06).pdf	11/01/2006

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.