Application and Claim for Unemployment Benefits and Employment Service

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0022 can be found here:

Documents and Forms

Document Name Document Type
Form UI-1 (03-12) Application and Claim for Unemployment Benefits and Employment Service Form
UI-1 (03-12) Application for Unemployment Benefits and Employment Ser Form UI-1 (03-12).pdf Form
UI-3 (02-09) Claim for Unemployment Benefits Form UI-3 (02-09).pdf Form
UI-3 (Internet) (0 Claim for Unemployment Benefits Form UI-3 (Internet) (08-04).pdf secure.RRB.gov/MainLine/PINPassword/login/Login.asp?App=RUIA Form
UI-1 (Internet) (0 Application for Unemployment Benefits and Employment Ser Form UI-1 (Internet) (03-04).pdf secure.RRB.gov/MainLine/PINPassword/login/Login.asp?App=RUIA Form
UB-10 (03-12).pdf UB-10, Unemployment Benefits for Railroad Employees (11-06) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application and Claim for Unemployment Benefits and Employment Service	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 325

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	UI-1 (03-12)	Application for Unemployment Benefits and Employment Service	Form UI-1 (03-12).pdf		No		Paper Only
Form	UI-3 (02-09)	Claim for Unemployment Benefits	Form UI-3 (02-09).pdf		No		Paper Only
Form	UI-3 (Internet) (08-04)	Claim for Unemployment Benefits	Form UI-3 (Internet) (08-04).pdf	https://secure.RRB.gov/MainLine/PINPassword/login/Login.asp?App=RUIA	Yes	Yes	Fillable Fileable Signable
Form	UI-1 (Internet) (03-04)	Application for Unemployment Benefits and Employment Service	Form UI-1 (Internet) (03-04).pdf	https://secure.RRB.gov/MainLine/PINPassword/login/Login.asp?App=RUIA	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title: RRB-7, Applications for Unemployment Benefits and Placement Service	FR Citation: 79 FR 58874

Number of Respondents: 81,662	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 34 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	81,662	-14,478	96,140
Annual IC Time Burden (Hours)	8,901	-1,616	10,517
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
UB-10, Unemployment Benefits for Railroad Employees (11-06)	UB-10 (03-12).pdf	03/26/2014

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