Railroad Unemployment Insurance Act Applications

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 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form ID-11A (04-17) Railroad Unemployment Insurance Act Applications Form and Instruction
Form ID-11A (04-17) Railroad Unemployment Insurance Act Applications Form and Instruction
Form SI-1b (06-09) Railroad Unemployment Insurance Act Applications Form and Instruction
Form SI-1b (06-09) Railroad Unemployment Insurance Act Applications Form and Instruction
Request OMB Approval of NonSubstantive Change to ICR 3220-0039_Signed.pdf Justification for No Material/Nonsubstantive Change
Request OMB Approval of NonSubstantive Change to ICR 3220-0039_Signed.pdf Justification for No Material/Nonsubstantive Change
Form SI-8 (XX-XX) - Proposed Example Per OMB.pdf Supplementary Document
Form SI-8 (XX-XX) - Proposed Example Per OMB.pdf Supplementary Document
Form SI-7 (XX-XX) - Proposed Example Per OMB.pdf Supplementary Document
Form SI-7 (XX-XX) - Proposed Example Per OMB.pdf Supplementary Document
Form SI-1b (XX-XX) - Proposed Example Per OMB.pdf Supplementary Document
Form SI-1b (XX-XX) - Proposed Example Per OMB.pdf Supplementary Document
Form SI-1A (XX-XX) - Proposed Example Per OMB.pdf Supplementary Document
Form SI-1A (XX-XX) - Proposed Example Per OMB.pdf Supplementary Document
Example Form SI-8 - Per OMB.pdf Supplementary Document
Example Form SI-8 - Per OMB.pdf Supplementary Document
Example Form SI-7 - Per OMB.pdf Supplementary Document
Example Form SI-7 - Per OMB.pdf Supplementary Document
Example of Form SI-1b - Per OMB.pdf Supplementary Document
Example of Form SI-1b - Per OMB.pdf Supplementary Document
Example of Form SI-1A - Per OMB.pdf Supplementary Document
Example of Form SI-1A - Per OMB.pdf Supplementary Document
3220-0039.docx Supporting Statement A
3220-0039.docx Supporting Statement A
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

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

OMB Details

Railroad Unemployment Insurance Act Applications

Federal Enterprise Architecture: Income Security - Unemployment Compensation

Form SI-1A (03-12)	Application for Sickness Benefits	www.rrb.gov/pdf/PandS/ub11.pdf	Form
Form ID-11A (04-17)	Requesting Reason for Late Filing of Sickness Benefit	Paper Only	Form and instruction
Form SI-3 (Internet)(10-10)	Claim for Sickness Benefits	Fillable Fileable Signable	Form and instruction
Form SI-3 (02-09)	Claim for Sickness Benefits	Paper Only	Form

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