Information Collection

Application and Claim for RUIA Benefits Due at Death

IC 33869 under ICR 201501-3220-001 · OMB 3220-0055.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0055 can be found here:

Documents and Forms

Document Name Document Type
Form UI-63 (02-09) Application and Claim for RUIA Benefits Due at Death Form and Instruction
UI-63 (02-09) Application for Benefits Due But Unpaid at Death Form UI-63 (02-09).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application and Claim for RUIA Benefits Due at Death	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 355.5 20 CFR 325.5

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	UI-63 (02-09)	Application for Benefits Due But Unpaid at Death	Form UI-63 (02-09).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title: RRB-21; Railroad Unemployment and Sickness Insurance Benefit System	FR Citation: 79 FR 58874

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.