Information Collection Request

RUIA Claims Notification and Verification System

ICR 202103-3220-001 · OMB 3220-0171 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form ID-4K (Internet) Prepayment Notice of Employees' Applications and Claims for Benefits Under the RUIA Form Modified Repair queued
Form ID-4K Prepayment Notice of Employees' Applications and Claims for Benefits Under the RUIA Form Modified Repair queued
Form ID-4E (Internet) Notice of RUIA Claim Determination Form Modified Repair queued
Form ID-4E Notice of RUIA Claim Determination Form Modified Repair queued
Form ID-4E RUIA Claims Notification System Form Modified Repair queued
3220-0171.docx Supporting Statement A Uploaded 2021-03-31 Repair queued
Form BA-12 (09-19).pdf Supplementary Document Uploaded 2021-03-30 Repair queued
Program Letter UI-C 229 (01-19).pdf Supplementary Document Uploaded 2021-03-30 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
33972 RUIA Claims Notification System Form ModifiedPrepayment Notice of Employees' Applications and Claims for Benefits Under the RUIA
33972 RUIA Claims Notification System Form ModifiedPrepayment Notice of Employees' Applications and Claims for Benefits Under the RUIA
33972 RUIA Claims Notification System Form ModifiedNotice of RUIA Claim Determination
33972 RUIA Claims Notification System Form ModifiedNotice of RUIA Claim Determination
33972 RUIA Claims Notification System Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
04/30/2025 36 Months From Approved 04/30/2022
85,820 0 81,920
2,484 0 2,391
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
RUIA Claims Notification System ID-4K (Internet), ID-4E, ID-4E (Internet), ID-4K ,   ,   ,  

table that charts list of burden
  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 85,820 81,920 0 3,900 0 0
Annual Time Burden (Hours) 2,484 2,391 0 93 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No