OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Railroad Unemployment Insurance Act Applications

OMB 3220-0039 ยท RRB.

OMB 3220-0039

Under Section 2 of the Railroad Unemployment Insurance Act, sickness benefits are payable to qualified railroad employees who are unable to work because of illness or injury. The collection obtains information from railroad employees and physicians needed to determine eligibility to and the amount of such benefits.

The latest form for Railroad Unemployment Insurance Act Applications expires 2028-07-31 and is listed under ICR 202411-3220-016.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SI-3 (08-21) Claim for Sickness BenefitsForm
Form SI-1A (08-21) Application for Sickness BenefitsForm
Form SI-3 (Internet)(08 Claim for Sickness BenefitsForm and Instruction
Form ID-11A (04-17) Requesting Reason for Late Filing of Sickness BenefitForm and Instruction
Form ID-11A (04-17) Railroad Unemployment Insurance Act ApplicationsForm and Instruction
Form SI-8 (08-21) Verification of Medical InformationForm and Instruction
Form SI-7 (08-23) Supplemental Doctor's StatementForm and Instruction
Form SI-1b (08-21) Statement of SicknessForm and Instruction
Form SI-1b (08-21) Railroad Unemployment Insurance Act ApplicationsForm and Instruction
3220-0039_Final.docxSupporting Statement A
Request OMB Approval of NonSubstantive Change to ICR 3220-0039_Signed.pdfJustification for No Material/Nonsubstantive Change
Request OMB Approval of NonSubstantive Change to ICR 3220-0039_Signed.pdf Justification for No Material/Nonsubstantive Change
Railroad Unemployment Insurance Act Applications Form
Railroad Unemployment Insurance Act Applications Form
Railroad Unemployment Insurance Act Applications Form and Instruction
Railroad Unemployment Insurance Act Applications Form and Instruction
Railroad Unemployment Insurance Act Applications Form and Instruction
Railroad Unemployment Insurance Act Applications Form and Instruction
Railroad Unemployment Insurance Act Applications Form and Instruction
Railroad Unemployment Insurance Act Applications Form and Instruction
Railroad Unemployment Insurance Act Applications Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202411-3220-016 Reinstatement without change of a previously approved collection 2025-01-10
202308-3220-002 No material or nonsubstantive change to a currently approved collection 2023-08-02 Approved without change
202007-3220-001 Revision of a currently approved collection 2020-08-24
201706-3220-001 Extension without change of a currently approved collection 2017-06-08 Approved without change
201401-3220-009 Revision of a currently approved collection 2014-03-30 Approved without change
201007-3220-001 Revision of a currently approved collection 2010-07-28 Approved without change
200812-3220-003 Revision of a currently approved collection 2008-12-30 Approved without change
200703-3220-001 Revision of a currently approved collection 2007-03-23 Approved with change
200401-3220-002 Revision of a currently approved collection 2004-01-28 Approved without change
200101-3220-001 Revision of a currently approved collection 2001-01-02 Approved without change
199802-3220-001 Revision of a currently approved collection 1998-02-20 Approved without change
199501-3220-001 Revision of a currently approved collection 1995-01-05 Approved without change
199405-3220-004 No material or nonsubstantive change to a currently approved collection 1994-05-23 Approved with change
199108-3220-002 Revision of a currently approved collection 1991-08-28 Approved without change
199005-3220-003 Revision of a currently approved collection 1990-05-04 Approved without change
198709-3220-006 No material or nonsubstantive change to a currently approved collection 1987-09-30 Approved with change
198704-3220-002 Revision of a currently approved collection 1987-04-28 Approved without change
198609-3220-003 No material or nonsubstantive change to a currently approved collection 1986-09-30 Approved with change
198509-3220-006 No material or nonsubstantive change to a currently approved collection 1985-09-06 Approved with change
198408-3220-005 No material or nonsubstantive change to a currently approved collection 1984-08-22 Approved with change
198403-3220-001 Revision of a currently approved collection 1984-03-26 Approved without change
198106-3220-004 No material or nonsubstantive change to a currently approved collection 1981-06-23 Approved with change
198105-3220-026 No material or nonsubstantive change to a currently approved collection 1981-05-28 Approved with change
198103-3220-002 Revision of a currently approved collection 1981-03-25 Approved without change
198102-3220-032 Revision of a currently approved collection 1981-02-25 Approved without change
197606-3220-001 Revision of a currently approved collection 1976-06-25 Approved without change
197605-3220-001 Extension without change of a currently approved collection 1976-05-04 Approved without change
197504-3220-011 No material or nonsubstantive change to a currently approved collection 1975-04-05 Approved with change

OMB Details

Railroad Unemployment Insurance Act Applications

Federal Enterprise Architecture: Income Security - Unemployment Compensation

Information collection instruments
FormNameElectronic accessType
Form SI-1A (08-21)Application for Sickness BenefitsPrintable OnlyForm
Form ID-11A (04-17)Requesting Reason for Late Filing of Sickness BenefitPaper OnlyForm and instruction
Form SI-3 (Internet)(08-21)Claim for Sickness BenefitsFillable Fileable SignableForm and instruction
Form SI-3 (08-21)Claim for Sickness BenefitsPaper OnlyForm

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