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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Supplemental Information on Accident and Insurance
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 340
20 CFR 341
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
SI-1C (03-02)
Supplemental Information on Accident and Insurance
Form SI-1c (03-02).pdf
No
Paper Only
Form and Instruction
SI-1c (proposed)
Supplemental Information on Accident and Insurance
Form SI-1c (proposed).pdf
No
Paper Only
Form
ID-30K (03-02)
Form Letter Asking Claimant for Additional Information on Injury or Illness
Form ID-30K (03-02).pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Litigation and Judicial Activities
Subfunction:
Resolution Facilitation
Privacy Act System of Records
Title:
RRB-21, Railroad Unemployment and Sickness Insurance Benefit System
FR Citation:
73 FR 73514
Number of Respondents:
3,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
3,000
0
0
-25,500
0
28,500
Annual IC Time Burden (Hours)
250
0
0
-1,443
0
1,693
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.