Statement of Authority to Act for Employee

OMB 3220-0034

Under 20 CFR 335.2, the Railroad Retirement Board (RRB) accepts claims for sickness benefits by other than the sick or injured employees, provided the RRB has the information needed to satisfy itself that the delegation should be made.

The latest form for Statement of Authority to Act for Employee expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SI-10 (05-17) Statement of Authority to Act for Employee Form
3220-0034 .docx Supporting Statement A
Statement of Authority to Act for Employee Form

All Historical Document Collections

202406-3220-004	Revision of a currently approved collection	2024-06-27
202012-3220-003	Extension without change of a currently approved collection	2020-12-10
201710-3220-002 Approved without change	Extension without change of a currently approved collection	2017-10-20
201407-3220-003 Approved without change	Extension without change of a currently approved collection	2014-08-20
201107-3220-002 Approved without change	Extension without change of a currently approved collection	2011-07-21
200805-3220-002 Approved without change	Extension without change of a currently approved collection	2008-05-29
200505-3220-001 Approved without change	Extension without change of a currently approved collection	2005-05-26
200207-3220-001 Approved without change	Extension without change of a currently approved collection	2002-07-15
199909-3220-003 Approved without change	Extension without change of a currently approved collection	1999-09-30
199610-3220-003 Approved without change	Extension without change of a currently approved collection	1996-10-31
199310-3220-003 Approved without change	Extension without change of a currently approved collection	1993-10-15
199010-3220-002 Approved without change	Revision of a currently approved collection	1990-10-29
198707-3220-001 Approved without change	Extension without change of a currently approved collection	1987-07-09
198409-3220-001 Approved without change	Extension without change of a currently approved collection	1984-09-25
198109-3220-001 Approved without change	Extension without change of a currently approved collection	1981-09-24
198105-3220-008 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-05-28
198103-3220-016 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-03-21
198102-3220-025 Approved without change	Reinstatement with change of a previously approved collection	1981-02-19
198010-3220-002 Approved with change	No material or nonsubstantive change to a currently approved collection	1980-10-28
198003-3220-020 Approved with change	No material or nonsubstantive change to a currently approved collection	1980-03-25
197909-3220-007 Approved without change	Revision of a currently approved collection	1979-09-28
197907-3220-020 Approved with change	No material or nonsubstantive change to a currently approved collection	1979-07-18
197808-3220-002 Approved without change	Extension without change of a currently approved collection	1978-08-30