View Information Collection Request (ICR) Package
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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:
3220-0039
ICR Reference No:
202007-3220-001
Status:
Historical Active
Previous ICR Reference No:
201706-3220-001
Agency/Subagency:
RRB
Agency Tracking No:
Title:
Railroad Unemployment Insurance Act Applications
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
07/28/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/24/2020
Terms of Clearance:
In response to comments, Agency updated forms to state that a "health care provider" could complete form instead of using the term "doctor."
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2024
36 Months From Approved
07/31/2021
Responses
245,724
0
245,724
Time Burden (Hours)
23,604
0
23,604
Cost Burden (Dollars)
0
0
0
Abstract:
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.
Authorizing Statute(s):
US Code:
45 USC 362 (i)
Name of Law: Railroad Unemploment Insurance Act
US Code:
45 USC 362(n)
Name of Law: Railroad Unemployment Insurance Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
85 FR 36888
06/18/2020
30-day Notice:
Federal Register Citation:
Citation Date:
85 FR 51795
08/21/2020
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
2
IC Title
Form No.
Form Name
Railroad Unemployment Insurance Act Applications
SI-8 (02-17), SI-7 (03-17), SI-1b (06-09), SI-1b (xx-xx)
Statement of Sickness
,
Supplemental Doctor's Statement
,
Verification of Medical Information
,
Statement of Sickness
Railroad Unemployment Insurance Act Applications
SI-1A (03-12), SI-3 (02-09), SI-3 (Internet)(10-10) , ID-11A (04-17), SI-3 (Internet) (xx-xx)
Requesting Reason for Late Filing of Sickness Benefit
,
Claim for Sickness Benefits
,
Application for Sickness Benefits
,
Claim for Sickness Benefits
,
Claim for Sickness Benefits
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
245,724
245,724
0
0
0
0
Annual Time Burden (Hours)
23,604
23,604
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
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
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
08/24/2020
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