Information Collection

Claimant Appeal Under the Railroad Retirement Act or Railroad Unemployment Insurance Act

IC 33804 under ICR 201502-3220-002 · OMB 3220-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0007 can be found here:

Documents and Forms

Document Name Document Type
Form HA-1 Claimant Appeal Under the Railroad Retirement Act or Railroad Unemployment Insurance Act Form
HA-1 Claimant Appeal Under the Railroad Retirement Act or Rai Form HA-1 (04-12).pdf www.rrb.gov/pdf/ha1.pdf Form
Form HA-2 (02-12).pdf Form HA-2, Filing Appeals Under the Railroad Retirement Act and the Railroad Unemployment Insurance Act IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Claimant Appeal Under the Railroad Retirement Act or Railroad Unemployment Insurance Act	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 260 20 CFR 320

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-1	Claimant Appeal Under the Railroad Retirement Act or Railroad Unemployment Insurance Act	Form HA-1 (04-12).pdf	http://www.rrb.gov/pdf/ha1.pdf	Yes	No	Printable Only

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records
Title: RRB-17, Appeal Decisions from Initial Denial for Benefits Under the Provisions of the Railroad Retirement Act	FR Citation: 79 FR 58874

Number of Respondents: 450	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	550	-50	600
Annual IC Time Burden (Hours)	185	-15	200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Form HA-2, Filing Appeals Under the Railroad Retirement Act and the Railroad Unemployment Insurance Act	Form HA-2 (02-12).pdf	02/27/2015

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