View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Supplemental Information on Accident and Insurance
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 341 20 CFR 340

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SI-5 (12-93) No   Paper Only
Form and Instruction ID-3S (03-09) Yes Yes Fillable Fileable Signable
Form and Instruction ID-3S-1 (08-17) No   Paper Only
Form and Instruction ID-3U (03-09) Yes Yes Fillable Fileable Signable
Form and Instruction ID-30K-1 (05-17) No   Paper Only
Form and Instruction ID-3S (Internet) (09-14) https://secure.rrb.gov/ERSNet/login.aspx Yes Yes Fillable Fileable
Form and Instruction ID-3U (Internet) (09-14) https://secure.rrb.gov/ERSNet/login.aspx Yes Yes Fillable Fileable

Litigation and Judicial Activities Resolution Facilitation

RRB-21, Railroad Unemployment and Sickness Benefit System   79 FR 58874

1,325 0
   
Private Sector Businesses or other for-profits
 
   77 %

  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 9,672 0 -600 0 0 10,272
Annual IC Time Burden (Hours) 486 0 -30 0 0 516
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Notice of Lien Transmittal Letter 09/22/2017
Notice of Lien Transmittal Letter 09/22/2017
Notice of Lien Transmittal Letter 07/16/2014
Program Letter 2006-05, E-Mail Requests for 12(o) and 2(f) reimbursements 09/12/2017
ID-30D-1, Request for Information on Injury or Illness 07/16/2014
Program Letter 2007-02, Employer Responsibilities under 12(o) and 2(f) 09/12/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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