Information Collection

Appeal Under the Railroad Retirement and Railroad Unemployment Insurance Act

IC 33804 under ICR 201201-3220-002 · OMB 3220-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0007 can be found here:

Documents and Forms

Document Name Document Type
Form HA-1 Appeal Under the Railroad Retirement and Railroad Unemployment Insurance Act Form
HA-1 Appeal Under the Railroad Retirement or Railroad Unemplo HA-1 (08-07).pdf http:www.rrb.gov/ha1/pdf Form
HA-1 (proposed) Appeal under the Railroad Retirement Act or Railroad Une Form HA-1 (proposed).pdf Form
Form HA-2 (02-98).pdf Form HA-2, Procedures Governing Appeals Under the Railroad Retirement Act and Railroad Unemployment Insurance Act IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Appeal Under the Railroad Retirement and Railroad Unemployment Insurance Act	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 320 20 CFR 260

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-1	Appeal Under the Railroad Retirement or Railroad Unemployment Insurance Act	HA-1 (08-07).pdf	http:www.rrb.gov/ha1/pdf	Yes	No	Printable Only
Form	HA-1 (proposed)	Appeal under the Railroad Retirement Act or Railroad Unemployment Insurance Act	Form HA-1 (proposed).pdf		No		Paper Only

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records
Title: RRB-17, Appeal Decisions from Initial Denial for Benefits Under the Provisions of the Railroad Retirement Act	FR Citation: 75 FR 43721

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	600	-50	650
Annual IC Time Burden (Hours)	200	-17	217
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Form HA-2, Procedures Governing Appeals Under the Railroad Retirement Act and Railroad Unemployment Insurance Act	Form HA-2 (02-98).pdf	12/29/2008

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