OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Supplemental Information on Accident and Insurance

OMB 3220-0036 ยท RRB.

OMB 3220-0036

The Railroad Unemployment Insurance Act provides for the recovery of sickness benefits paid if an employee receives a settlement for the same injury for which benefits were paid. The collection obtains information that is needed to determine the amount of the RRB's reimbursement from the person or company responsible for such payments.

The latest form for Supplemental Information on Accident and Insurance expires 2027-08-31 and is listed under ICR 202406-3220-005.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SI-1C (04-17) Supplemental Information on Accident and InsuranceForm and Instruction
Form SI-5 (12-93) Supplemental Information on Accident and InsuranceForm and Instruction
3220-0036.docxSupporting Statement A
Supplemental Information on Accident and Insurance Form and Instruction
Supplemental Information on Accident and Insurance Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202406-3220-005 Revision of a currently approved collection 2024-06-27 Approved without change
202011-3220-001 Revision of a currently approved collection 2020-11-24
201709-3220-001 Extension without change of a currently approved collection 2017-09-28 Approved without change
201407-3220-004 Revision of a currently approved collection 2014-08-01 Approved without change
201203-3220-001 Extension without change of a currently approved collection 2012-03-30 Approved without change
200901-3220-002 Revision of a currently approved collection 2009-01-28 Approved without change
200511-3220-004 Revision of a currently approved collection 2005-11-28 Approved without change
200504-3220-001 Extension without change of a currently approved collection 2005-04-04 Approved without change
200201-3220-003 Extension without change of a currently approved collection 2002-01-29 Approved without change
199811-3220-001 Revision of a currently approved collection 1998-11-20 Approved without change
199506-3220-005 Revision of a currently approved collection 1995-06-23 Approved without change
199307-3220-001 No material or nonsubstantive change to a currently approved collection 1993-07-12 Approved with change
199304-3220-002 Extension without change of a currently approved collection 1993-04-08 Approved without change
199205-3220-002 Revision of a currently approved collection 1992-05-01 Approved without change
199101-3220-001 Revision of a currently approved collection 1991-01-08 Approved without change
198710-3220-001 Extension without change of a currently approved collection 1987-10-02 Approved without change
198409-3220-004 Revision of a currently approved collection 1984-09-26 Approved without change
198209-3220-001 Extension without change of a currently approved collection 1982-09-20 Approved without change
198105-3220-009 No material or nonsubstantive change to a currently approved collection 1981-05-28 Approved with change
198103-3220-017 No material or nonsubstantive change to a currently approved collection 1981-03-21 Approved with change
198102-3220-049 No material or nonsubstantive change to a currently approved collection 1981-02-28 Approved with change
198011-3220-005 No material or nonsubstantive change to a currently approved collection 1980-11-15 Approved with change
198008-3220-005 No material or nonsubstantive change to a currently approved collection 1980-08-28 Approved with change
197908-3220-004 Revision of a currently approved collection 1979-08-17 Approved without change
197907-3220-007 Reinstatement without change of a previously approved collection 1979-07-31 Approved without change
197405-3220-001 New collection (Request for a new OMB Control Number) 1974-05-15 Approved without change

OMB Details

Supplemental Information on Accident and Insurance

Federal Enterprise Architecture: Litigation and Judicial Activities - Resolution Facilitation

Information collection instruments
FormNameElectronic accessType
Form SI-1C (04-17)Supplemental Information on Accident and InsurancePaper OnlyForm and instruction
Form ID-30K (05-17)Notice to Request Supplemental Information on Injury or IllnessPaper OnlyForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.