Agency Forms Submitted for OMB Review

SUMMARY:

In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35), the Railroad Retirement Board (RRB) has submitted the following proposal(s) for the collection of information to the Office of Management and Budget for review and approval.

Summary of Proposal(s)

(1) Collection title: Railroad Unemployment Insurance Act Applications.

(2) Form(s) submitted: SI-1a, SI-1b, SI-3, SI-7, SI-8, ID-7H, ID-11A, ID-11-B.

(3) OMB Number: 3220-0039.

(4) Expiration date of current OMB clearance: 5/31/2004.

(5) Type of request: Revision of a currently approved collection.

(6) Respondents: Individuals or households, Business or other for-profit.

(7) Estimated annual number of respondents: 44,600.

(8) Total annual responses: 260,900.

(9) Total annual reporting hours: 26,321.

(10) Collection description: 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.

Additional Information or Comments: Copies of the forms and supporting documents can be obtained from Charles Mierzwa, the agency clearance officer at (312) 751-3363 or Charles.Mierzwa@RRB.GOV.

Comments regarding the information collection should be addressed to Ronald J. Hodapp, Railroad Retirement Board, 844 North Rush Street, Chicago, Illinois, 60611-2092 or Ronald.Hodapp@RRB.GOV and to the OMB Desk Officer for the RRB, at the Office of Management and Budget, Room 10230, New Executive Office Building, Washington, DC 20503.