Financial Disclosure Statement

ICR 201406-3220-002

OMB: 3220-0127

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2014-06-24
IC Document Collections
IC ID
Document
Title
Status
33919 Modified
ICR Details
3220-0127 201406-3220-002
Historical Active 201104-3220-002
RRB
Financial Disclosure Statement
Extension without change of a currently approved collection   No
Regular
Approved without change 08/14/2014
Retrieve Notice of Action (NOA) 07/15/2014
  Inventory as of this Action Requested Previously Approved
08/31/2017 36 Months From Approved 08/31/2014
1,200 0 1,200
1,700 0 1,700
0 0 0

Under the Railroad Retirement and the Railroad Unemployment Insurance Acts, the Railroad Retirement Board has authority to secure from an overpaid beneficiary a statement of the individual's assets and liabilities if waiver of the overpayment is requested.

US Code: 45 USC 231i Name of Law: Railroad Retirement Act
   US Code: 45 USC 362(l) Name of Law: Railroad Unemployment Insurance Act
   US Code: 45 USC 231f (b)(5) Name of Law: Railroad Retirement Act
  
None

Not associated with rulemaking

  79 FR 20251 04/11/2014
79 FR 36339 06/26/2014
No

1
IC Title Form No. Form Name
Financial Disclosure Statement DR-423 (05-09) Financial Disclosure Statement

  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 1,200 1,200 0 0 0 0
Annual Time Burden (Hours) 1,700 1,700 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
No
No
No
Uncollected
Charles Mierzwa 312-751-3363 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
07/15/2014


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