Information Collection

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

IC 33804 under ICR 202411-3220-002 · OMB 3220-0007.

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 Claimant Appeal Under the Railroad Retirement Act or Railroad Unemployment Insurance Act	Form
Form HA-1 (XX-XX) Propo 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
HA-1 Claimant Appeal Under the Railroad Retirement Act or Rai HA-1 (03-22) Current.pdf	Form
HA-1 (XX-XX) Propo 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

IC Title:

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				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
	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].