Supplemental Information on Accident and Insurance

Supplemental Information on Accident and Insurance

OMB: 3220-0036

IC ID: 187866

Documents and Forms

Document Name Document Type
Form SI-5 (12-93) Supplemental Information on Accident and Insurance Form and Instruction
SI-5 (12-93) Report of Payments to Employee Claiming Sickness Benefits Under the RUIA Form SI-5 (12-93).pdf Form and Instruction
ID-3S (03-09) Request for Lien Information; Report of Settlement Form ID-3S (03-09).pdf Form and Instruction
ID-3S-1 (08-17) Lien Information Under Section 12(o) of the RUIA Form ID-3S1 (08-17).pdf Form and Instruction
ID-3U (03-09) Request for Section 2(f) Information Form ID-3u (03-09).pdf Form and Instruction
ID-3S (Internet) (09-14) Request for Lien Information; Report of Settlement Form ID-3S (Internet) (09-14) Screens.pdf secure.rrb.gov/ERSNet/login.aspx Form and Instruction
ID-3U (Internet) (09-14) Request for Section 2(f) Information Form ID-3U (Internet) (09-14) Screens.pdf secure.rrb.gov/ERSNet/login.aspx Form and Instruction
ID-3S (xx-xx) Request for Lien Information: Report of Settlement Form ID-3S (Paper) - Proposed (xx-xx).pdf Form and Instruction
ID-3U Request for Section 2(f) Information Form ID-3U (Paper) - Proposed (xx-xx).pdf Form and Instruction
Form ID-30B-1 (08-17).pdf Notice of Lien Transmittal Letter IC Document
Form ID-30B-2 (08-17).pdf Notice of Lien Transmittal Letter IC Document
Form ID-30B (08-12).pdf Notice of Lien Transmittal Letter IC Document
Program Letter (06-05) for E-Mail requests.pdf Program Letter 2006-05, E-Mail Requests for 12(o) and 2(f) reimbursements IC Document
Form ID-30D-1 (04-06).pdf ID-30D-1, Request for Information on Injury or Illness IC Document
Program Letter (07-02) for ERs under 2(f) & 12(o).pdf Program Letter 2007-02, Employer Responsibilities under 12(o) and 2(f) IC Document