Information Collection

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

IC 33804 under ICR 202106-3220-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form HA-1 Claimant Appeal Under the Railroad Retirement Act or Railroad Unemployment Insurance Act	Form
Form HA-1 Claimant Appeal Under the Railroad Retirement Act or Railroad Unemployment Insurance Act Claimant Appeal Under the Railroad Retirement Act or Railroad Unemployment Insurance Act	Form
Form HA-1 (xx-xx) - Pro Claimant Appeal Under the Railroad Retirement Act or Railroad Unemploment Insurance Act 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 (12-16).pdf www.rrb.gov/sites/default/files/2016-12/ha1.pdf	Form
HA-1 Claimant Appeal Under the Railroad Retirement Act or Rai Form HA-1 (12-16).pdf www.rrb.gov/sites/default/files/2016-12/ha1.pdf	Form
HA-1 (xx-xx) - Pro Claimant Appeal Under the Railroad Retirement Act or Rai Form HA-1 (xx-xx) - Proposed.pdf	Form
HA-1 (xx-xx) - Pro Claimant Appeal Under the Railroad Retirement Act or Rai Form HA-1 (xx-xx) - Proposed.pdf	Form
Form HA-2 (06-21).pdf Form HA-2, Filing Appeals Under the Railroad Retirement Act and the Railroad Unemployment Insurance Act	IC Document
Form HA-2 (06-21).pdf Form HA-2, Filing Appeals Under the Railroad Retirement Act and the Railroad Unemployment Insurance Act	IC Document

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-1			https://www.rrb.gov/sites/default/files/2016-12/ha1.pdf	Yes	No	Printable Only
Form	HA-1 (xx-xx) - Proposed				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: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	300	-250	0	550
Annual IC Time Burden (Hours)	100	-83	-2	185
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form HA-2, Filing Appeals Under the Railroad Retirement Act and the Railroad Unemployment Insurance Act		06/29/2021

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

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