View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 3220-0038	ICR Reference No: 201912-3220-002
Status: Historical Active	Previous ICR Reference No: 201609-3220-001
Agency/Subagency: RRB	Agency Tracking No:
Title: Medical Reports
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/03/2020
	Date Received in OIRA: 12/23/2019
Terms of Clearance: The agency shall meet with OMB before resubmission of the collection, within 24 months, to discuss reformatting G-3EMP to condense the questions.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2023	36 Months From Approved	12/31/2020
Responses	36,500	0	36,500
Time Burden (Hours)	10,201	0	10,201
Cost Burden (Dollars)	0	0	0

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Authorization to Disclose Information to the Railroad Retirement Board	G-197 (Proposed), G-197	,
Medical Reports	RL-11B (Proposed), RL-250 (Proposed), G-250 (Proposed), G-250, G-3EMP, G-250A, G-260, RL-11B, RL-250, G-260 (Proposed), G-250A (Proposed), G-3EMP (Proposed)	, , , , , , , , , , ,
Medical Reports	RL-11D (Proposed), RL-11D	,

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Brian Foster 312 751-4826 brian.foster@rrb.gov

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