Railroad Unemployment Insurance Act Applications

Forms and Documents

Document Name	Status
Form ID-11A (07-07) Railroad Unemployment Insurance Act Applications Form and Instruction	Modified
Form SI-1b (06-09) Railroad Unemployment Insurance Act Applications Form and Instruction	Modified
3220-0039.doc Supporting Statement A	2014-03-30

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	Modified

ICR Details

OMB Control No: 3220-0039	ICR Reference No: 201401-3220-009
Status: Historical Active	Previous ICR Reference No: 201007-3220-001
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 without change	Conclusion Date: 06/16/2014
	Date Received in OIRA: 03/30/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2017	18 Months From Approved	06/30/2014
Responses	213,949	0	197,500
Time Burden (Hours)	21,028	0	19,825
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:
	78 FR 57421	09/18/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 16382	03/25/2014
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	SI-1A (03-12), SI-3 (02-09), SI-3 (Internet)(10-10) , ID-11A (07-07)	Requesting Reason for Late Filing of Sickness Benefit ,   Claim for Sickness Benefits ,   Application for Sickness Benefits ,   Claim for Sickness Benefits
Railroad Unemployment Insurance Act Applications	SI-7 (06-09), SI-8 (06-09), SI-1b (06-09)	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	213,949	197,500	0	0	16,449	0
Annual Time Burden (Hours)	21,028	19,825	0	0	1,203	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The RRB has enhanced its tracking and reporting systems. Actual responses received (instead of estimates) can now be calculated and has resulted in an overall increase in the burden calculation. Notable changes were observed in the amount of claimants using our web-site as the SI-3 (Internet) showed an increase of 12,593 responses and 1,049 burden hours from previous estimates. Conversely, Forms ID-7H and ID-11B are being deleted from the information collection due to less than 10 responses per year being received. We are showing the overall increase of 16,449 responses an 1.203 burden hours as an adjustment.

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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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 03/30/2014

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