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Federal forms, ICRs, and supporting documents

Information Collection

Supplemental Information on Accident and Insurance

IC 33850 under ICR 202406-3220-005 · OMB 3220-0036.

Documents and Forms
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Form and Instruction
Form and Instruction
Form and Instruction
Form
Form
IC Document
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Information Collection (IC) Details

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Supplemental Information on Accident and Insurance
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 341 20 CFR 340

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SI-1C (04-17) Supplemental Information on Accident and Insurance Form SI-1c (04-17).pdf No   Paper Only
Form ID-30K (05-17) Notice to Request Supplemental Information on Injury or Illness Form ID-30K (05-17).pdf No   Paper Only

Litigation and Judicial Activities Resolution Facilitation

RRB-21, Railroad Unemployment and Sickness Insurance Benefit System  78 FR 58874

914 0
   
Individuals or Households
 
   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 914 0 -886 0 0 1,800
Annual IC Time Burden (Hours) 76 0 -74 0 0 150
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
ID-30D, Request for Information on Injury or Illness Form ID-30D (04-06).pdf 09/12/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.