Railroad Unemployment Insurance Act Applications

Railroad Unemployment Insurance Act Applications

OMB: 3220-0039

IC ID: 33857

Information Collection (IC) Details

View Information Collection (IC)

Railroad Unemployment Insurance Act Applications
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 335

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction ID-11A (07-07) Requesting Reason for Late Filing of Sickness Benefit Form ID-11A (07-07).pdf No   Paper Only
Form and Instruction SI-3 (Internet)(10-10) Claim for Sickness Benefits SI-3 (Internet) (10-10).pdf Yes Yes Fillable Fileable Signable
Form SI-1A (03-12) Application for Sickness Benefits Form SI-1A (03-12).pdf http://www.rrb.gov/pdf/PandS/ub11.pdf Yes No Printable Only
Form SI-3 (02-09) Claim for Sickness Benefits SI-3 (02-09).pdf No   Paper Only

Income Security Unemployment Compensation

RRB-21-Railroad Unemployment and Sickness Insurance Benefit System  75 FR 43725

16,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 176,451 0 0 18,601 0 157,850
Annual IC Time Burden (Hours) 16,030 0 0 1,489 0 14,541
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
UB-11, Sickness Benefits for Railroad Employees UB-11 (03-12).pdf 03/27/2014
ID-7H Non-Entitlement to Sickness Benefits and Information on Unemployment Insurance Benefits Form ID-7H (09-99).pdf 03/30/2014
ID-11B, Notice of Insufficient Medical and Late Filing Form ID-11B (07-07).pdf 03/30/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy