Supplemental Information on Accident and Insurance

ICR 201709-3220-001

OMB: 3220-0036

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Supporting Statement A
2017-09-28
ICR Details
3220-0036 201709-3220-001
Active 201407-3220-004
RRB
Supplemental Information on Accident and Insurance
Extension without change of a currently approved collection   No
Regular
Approved without change 11/30/2017
Retrieve Notice of Action (NOA) 09/28/2017
Note that because of the program change due to agency discretion, this collection should have been submitted as a revision.
  Inventory as of this Action Requested Previously Approved
11/30/2020 36 Months From Approved 11/30/2017
10,202 0 10,802
531 0 561
0 0 0

The Railroad Unemployment Insurance Act provides for the recovery of sickness benefits paid if an employee receives a settlement for the same injury for which benefits were paid. The collection obtains information that is needed to determine the amount of the RRB's reimbursement from the person or company responsible for such payments.

US Code: 45 USC 362(l) Name of Law: Railroad Unemployment Insurance Act
   US Code: 45 USC 362(o) Name of Law: Railroad Unemployment Insurance Act
  
None

Not associated with rulemaking

  82 FR 31108 07/05/2017
82 FR 43052 09/13/2017
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 10,202 10,802 0 -600 0 0
Annual Time Burden (Hours) 531 561 0 -30 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Using Information Technology
Decrease is due to a reduction in the use of Form ID-3u for job protection payments in the rail industry; the removal of the email versions of Forms ID-3s and ID-3u; and improved tracking capabilities that allow the RRB to more accurately determine the amount of annual responses.

$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.
09/28/2017


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