3220-0055

OMB NO. 3220-0055

Justification

Application and Claim for RUIA Benefits Unpaid at Death

RRB Form UI-63

1. Circumstances of the collection - Under Section 2(g) of the Railroad Unemployment Insurance Act (RUIA), benefits under that Act that accrued but were not paid because of the death of the employee shall be paid to the same individual(s) to whom benefits are payable under section 6(a)(1) of the Railroad Retirement Act. The provisions relating to the payment of such benefits are prescribed in 20 CFR 325.5 and 20 CFR 335.5.

2. Purposes of collecting/consequences of not collecting the information - The collection obtains the information needed by the Railroad Retirement Board (RRB) to properly and fully pay all unemployment and sickness benefits accrued but unpaid because of the death of the employee.

The RRB provides Form UI-63, Application for Benefits Due But Unpaid at Death, for use in applying for accrued sickness or unemployment benefits unpaid at the death of the employee and for supplying the information needed by the RRB to identify the proper payee(s). Following the order for payment of beneficiaries under the Railroad Retirement Act, accrued RUIA benefits are distributed 1) first, to the surviving spouse; 2) if there is no surviving spouse, then to the person who paid the funeral and burial expenses (to the extent the expenses were not reimbursed under the RRA); and 3) if there are still unpaid benefits remaining, then to the children, grandchildren, parents, and brothers and sisters, in order of survivorship.

Form UI-63 is not requested if unpaid benefits under the RRA were applied for, since whoever is identified as being the proper beneficiary under the RRA is also the proper payee under the RUIA. When required, Form UI-63 must be filed within two years of the death of the employee; otherwise, any unpaid RUIA benefits will revert to the RUIA account.

Form UI-63 is either completed at one of our RRB field offices or is mailed to the applicant by the field office. A transmittal letter containing instructions for completing and filing the UI-63 is on the reverse side of the form for use when the form is mailed to an applicant. On these occasions, a pre-addressed return envelope is also enclosed for returning the completed UI-63 to the field office. The name and social security number of the deceased employee are pre-filled prior to being released to the respondent for completion.

The RRB proposes the following changes to Form UI-63.

• Remove unnecessary text from the reference area and Item 1 of the application due to prefilling of the deceased Employee’s name and Social Security Number;

• Add “enclosure” to the bottom of Page 1;

• Move the Paperwork Reduction Act notice from the first page to the top of the form;

• Change “the person named above” and “his/her” reference to the widow(er) in Items 2(a) and 2(b);

• In item 3b, for clarity, change “any person” to “they” so the user knows that the sentence is not referring to more than one person;

• Under the “Yes” response, change “Explain below” to “Provide details below. If additional space is needed, use a separate sheet of paper”;

• Change “Explanation” to “Details:” and add more space for a written response;

• Other minor editorial changes.

To our knowledge, no other agency uses a form similar to Form UI-63.

3. Planned use of improved information technology or technical/legal impediments to further burden reduction – Not cost effective due to low volume.

4. Efforts to identify duplication - This information collection does not duplicate any other information collection.

5. Small business respondents - N.A.

6. Consequences of less frequent collection - Not applicable since the information is solicited only once.

7. Special circumstances - None.

8. Public comments/consultations outside the agency - In accordance with 5 CFR 1320.8(d), comments were invited from the public regarding this information collection. The notice to the public was published on page 51535 & 51536 of the September 3, 2008, Federal Register. No comments or requests for additional information were received from the public.

9. Payments or gifts to respondents - N.A.

10. Confidentiality - Privacy Act System of Records, RRB 21, Railroad Unemployment and Sickness Insurance Benefit System.

11. Sensitive questions - N.A.

12. Estimate of respondent burden - The estimated annual burden for the information collection remains unchanged as follows:

Form #	Annual Responses	Time (Min)	Burden (Hrs)
UI-63	200	7	23
Total	200		23

13. Estimated annual cost to respondents or record keepers - N.A.

14. Estimate of cost to Federal Government - N.A.

15. Explanation for change in burden - N.A.

16. Time schedule for data collection and publication - The results of this collection will not be published.

17. Request not to display OMB expiration date - The UI-63 is a low usage form that is seldom revised. Given the costs associated with redrafting, reprinting, and distributing the forms in order to keep the appropriate OMB expiration date in place, the RRB requests the authority to not display the expiration date on the form.

18. Exceptions to Certification Statement - None

3