Railroad Unemployment Insurance Act Applications

ICR 201706-3220-001

OMB: 3220-0039

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Supporting Statement A
2017-06-08
ICR Details
3220-0039 201706-3220-001
Active 201401-3220-009
RRB
Railroad Unemployment Insurance Act Applications
Extension without change of a currently approved collection   No
Regular
Approved without change 08/28/2017
Retrieve Notice of Action (NOA) 06/08/2017
  Inventory as of this Action Requested Previously Approved
08/31/2020 36 Months From Approved 08/31/2017
245,724 0 213,949
23,604 0 21,028
0 0 0

Under Section 2 of the Railroad Unemployment Insurance Act, sickness benefits are payable to qualified railroad employees who are unable to work because of illness or injury. The collection obtains information from railroad employees and physicians needed to determine eligibility to and the amount of such benefits.

US Code: 45 USC 362 (i) Name of Law: Railroad Unemploment Insurance Act
   US Code: 45 USC 362(n) Name of Law: Railroad Unemployment Insurance Act
  
None

Not associated with rulemaking

  82 FR 12859 03/07/2017
82 FR 24169 05/25/2017
No

2
IC Title Form No. Form Name
Railroad Unemployment Insurance Act Applications SI-8 (02-17), SI-7 (03-17), SI-1b (06-09) Statement of Sickness ,   Supplemental Doctor's Statement ,   Verification of Medical Information
Railroad Unemployment Insurance Act Applications SI-1A (03-12), SI-3 (02-09), SI-3 (Internet)(10-10) , ID-11A (04-17) Requesting Reason for Late Filing of Sickness Benefit ,   Claim for Sickness Benefits ,   Application for Sickness Benefits ,   Claim for Sickness Benefits

  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 245,724 213,949 0 31,775 0 0
Annual Time Burden (Hours) 23,604 21,028 0 2,576 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Using Information Technology
The RRB has enhanced its tracking and reporting systems. Actual responses received (instead of estimates) can now be calculated and has resulted in a more accurate and increased overall burden estimate for the information collection.

$0
No
    Yes
    Yes
No
No
No
Uncollected
Brian Foster 312 751-4826 [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.
06/08/2017


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