Medical Reports

ICR 201412-3220-001

OMB: 3220-0038

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Supporting Statement A
2015-02-25
Supplementary Document
2014-12-05
ICR Details
3220-0038 201412-3220-001
Historical Active 201111-3220-002
RRB
Medical Reports
Revision of a currently approved collection   No
Regular
Approved without change 04/27/2015
Retrieve Notice of Action (NOA) 02/25/2015
  Inventory as of this Action Requested Previously Approved
04/30/2018 36 Months From Approved 04/30/2015
35,900 0 35,900
10,001 0 10,001
0 0 0

The Railroad Retirement Act provides disability annuities for qualified railroad employees whose physical or mental condition renders them incapable of working in their regular occupation (occupational disability) or any occupation (total disability). The medical reports obtain information needed for determining the nature and severity of the impairment.

US Code: 45 USC 231f Name of Law: Railroad Retirement Act
  
None

Not associated with rulemaking

  79 FR 63653 10/24/2014
79 FR 78506 12/30/2014
No

  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 35,900 35,900 0 0 0 0
Annual Time Burden (Hours) 10,001 10,001 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
Yes
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.
02/25/2015


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