ID-3S Internet Screen Descriptions

Attachment
Form ID-3s (Internet)
The proposed Form ID-3s (Internet), Request for Lien Information – Report of Settlement, is not
a paper form but rather a process accessed through internet screens. Although it collects the
same information as the approved paper/facsimile version of Form ID-3s, it consists of a screen
which collects the necessary information and provides for the required notices and certifications.
The user accesses Form ID-3s (Internet) through the Employer Reporting System (ERS) on the
RRB’s website (Screen 1).
1.

The combination of the user ID and password serves as the user’s signature for certifying
the information while logged onto the system (Screen 2).

2.

Upon logging onto ERS, the system presents the user with the ERS Menu (Screen 3) and
the user selects the ID-3s from the forms listed under New Items.

3.

Form ID-3s (Internet) consists of a single screen (Screen 4) for each employee. The user
completes Items 1 through 9: 1. Employee name; 2. Employee social security number; 3.
Date(s) of injury; 4. “Yes” or “No” to indicate whether or not the request is for informational
purposes only; 5. Employee return to work date; 6. “Yes” or “No” to indicate whether or not
the case has settled; 7. Exact time period to which pay for time lost is allocated, if
applicable; 8. The amount withheld from the settlement for reimbursement to the RRB and
the gross amount of the settlement; 9. Remarks section which is optional for employers to
add remarks; e.g.: “no injury date, cumulative trauma.” Item 10 is prefilled with identifying
information from the employers ERS login ID.

4.

After completing the necessary items, the user has the option of clicking:
 Submit to submit the information;
 Save and Return to save the information and return to the ERS Menu screen;
 Print to print the form for their records, which they can only do after they have
successfully submitted the information;
 Reset Record to clear the completed items if they need to correct any information
entered;
 Exit/No Action to return to the ERS Menu screen without saving any information.

5.

When the user submits Form ID-3s, it will automatically be moved from New Items to
Completed Items on the ERS menu (Screen 5).

6.

The Paperwork Reduction Act Notice (Screen 6) is accessed by clicking the Paperwork
Reduction Act Notice link.

7.

The Employer Instructions (Screen 7) are accessed by clicking the Employer
Instructions link.

8.

After the employer submits Form ID-3s via ERS, the RRB examiner uses their limited
administrator access to retrieve the form and complete Items 11 through 16. Item 11 is
the Payor Code for the employer associated with the lien. Item 13 is the lien amount to be
reimbursed to the RRB upon settlement along with a “Yes” or “No” entry in Item 14 to
indicate whether or not the case reported lien amount is final and the billing document
identification number associated with the lien amount. Item 15 is an optional box for the
RRB representative to add comments; e.g.: “Benefit year 2012 $999, Benefit Year 2013
$999.”

9.

After the employer submits Form ID-3s via ERS, requesting the reimbursement figure, the
RRB replies through ERS the next business day.

10.

After the RRB representative completes entry of Items 11 through 16 they have the option
of clicking:
 Submit to submit the lien information back to the employer (Upon submission a
copy of the Form ID-3s screen and all the data provided on it are sent to the RRB
Image System where it is retained for at least 7 years.); or
 Exit/No Action to return to the ERS Menu screen without saving any information.