OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Supplemental Information on Accident and Insurance

OMB 3220-0036 · 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 can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form and Instruction
Form and Instruction
Supporting Statement A
All Historical Document Collections
Approved without change
 Revision of a currently approved collection 2024-06-27
Revision of a currently approved collection 2020-11-24
Approved without change
 Extension without change of a currently approved collection 2017-09-28
Approved without change
 Revision of a currently approved collection 2014-08-01
Approved without change
 Extension without change of a currently approved collection 2012-03-30
Approved without change
 Revision of a currently approved collection 2009-01-28
Approved without change
 Revision of a currently approved collection 2005-11-28
Approved without change
 Extension without change of a currently approved collection 2005-04-04
Approved without change
 Extension without change of a currently approved collection 2002-01-29
Approved without change
 Revision of a currently approved collection 1998-11-20
Approved without change
 Revision of a currently approved collection 1995-06-23
Approved with change
 No material or nonsubstantive change to a currently approved collection 1993-07-12
Approved without change
 Extension without change of a currently approved collection 1993-04-08
Approved without change
 Revision of a currently approved collection 1992-05-01
Approved without change
 Revision of a currently approved collection 1991-01-08
Approved without change
 Extension without change of a currently approved collection 1987-10-02
Approved without change
 Revision of a currently approved collection 1984-09-26
Approved without change
 Extension without change of a currently approved collection 1982-09-20
Approved with change
 No material or nonsubstantive change to a currently approved collection 1981-05-28
Approved with change
 No material or nonsubstantive change to a currently approved collection 1981-03-21
Approved with change
 No material or nonsubstantive change to a currently approved collection 1981-02-28
Approved with change
 No material or nonsubstantive change to a currently approved collection 1980-11-15
Approved with change
 No material or nonsubstantive change to a currently approved collection 1980-08-28
Approved without change
 Revision of a currently approved collection 1979-08-17
Approved without change
 Reinstatement without change of a previously approved collection 1979-07-31
Approved without change
 New collection (Request for a new OMB Control Number) 1974-05-15
OMB Details

Supplemental Information on Accident and Insurance

Federal Enterprise Architecture: Litigation and Judicial Activities - Resolution Facilitation

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.