Railroad Unemployment Insurance Act Applications

Railroad Unemployment Insurance Act Applications

OMB: 3220-0039

IC ID: 179107

Information Collection (IC) Details

View Information Collection (IC)

Railroad Unemployment Insurance Act Applications
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
20 CFR 355

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SI-1b (06-09) Statement of Sickness Form SI-1b (06-09).pdf http:www.rrb.gov/pdf/PandS/ub11.pdf Yes No Printable Only
Form and Instruction SI-7 (03-17) Supplemental Doctor's Statement Form SI-7 (03-17).pdf No   Paper Only
Form and Instruction SI-8 (02-17) Verification of Medical Information Form SI-8 (02-17).pdf No   Paper Only
Form and Instruction SI-1b (xx-xx) Statement of Sickness Form SI-1b (xx-xx) - Proposed.pdf http:www.rrb.gov/pdf/PandS/ub11.pdf Yes No Printable Only

Income Security Unemployment Compensation

RRB-21, Railroad Unemployment and Sickness Insurance Benefit System  79 FR 58874

36,556 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 36,556 0 0 0 0 36,556
Annual IC Time Burden (Hours) 4,872 0 0 0 0 4,872
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
UB-11, Sickness Benefits for Railroad Employees UB-11 (03-12).pdf 03/27/2014
SI-10, Statement of Authority to ACt for Employee Form SI-10 (05-17) stand alone.pdf 08/20/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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