EMPLOYEE - EMPLOYER STATEMENT OF PAY RATE

ICR 197612-3220-004

OMB: 3220-0110

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
177139 Migrated
ICR Details
3220-0110 197612-3220-004
Historical Active 197607-3220-001
RRB
EMPLOYEE - EMPLOYER STATEMENT OF PAY RATE
No material or nonsubstantive change to a currently approved collection   No
Emergency 12/15/1976
Approved with change 12/15/1976
Retrieve Notice of Action (NOA) 12/15/1976
  Inventory as of this Action Requested Previously Approved
07/31/1981 07/31/1981 07/31/1981
600 0 600
200 0 200
0 0 0

UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT, THE DAILY BENEFIT RATE FOR UNEMPLOYMENT AND SICKNESS INSURANCE BENEFITS DEPENDS ON THE EMPLOYEE'S LAST DAILY RATE OF PAY. THE STATEMENT WILL OBTAIN PAY RATE INFORMATION FROM THE EMPLOYEE AND EMPLOYER ON A QUESTIONED BENEFIT RATE. THE INFORMATION WILL BE USED FOR DETERMINING IF AN INCREASE IN THE DAILY BENEFIT RATE IS DUE.

None
None


No

1
IC Title Form No. Form Name
EMPLOYEE - EMPLOYER STATEMENT OF PAY RATE UI-1G

  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 600 600 0 0 0 0
Annual Time Burden (Hours) 200 200 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/15/1976


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